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EP3808306B1 - Vorrichtung für endodontische behandlungen - Google Patents

Vorrichtung für endodontische behandlungen Download PDF

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Publication number
EP3808306B1
EP3808306B1 EP20190221.0A EP20190221A EP3808306B1 EP 3808306 B1 EP3808306 B1 EP 3808306B1 EP 20190221 A EP20190221 A EP 20190221A EP 3808306 B1 EP3808306 B1 EP 3808306B1
Authority
EP
European Patent Office
Prior art keywords
fluid
tooth
chamber
pressure
pressure wave
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Active
Application number
EP20190221.0A
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English (en)
French (fr)
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EP3808306A1 (de
Inventor
Bjarne Bergheim
Mehrzad Khakpour
Michele Pham
Morteza Gharib
Richard S TEBBS
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Sonendo Inc
Original Assignee
Sonendo Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US12/945,791 external-priority patent/US9492244B2/en
Application filed by Sonendo Inc filed Critical Sonendo Inc
Priority to EP23214493.1A priority Critical patent/EP4368142A3/de
Publication of EP3808306A1 publication Critical patent/EP3808306A1/de
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Publication of EP3808306B1 publication Critical patent/EP3808306B1/de
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C5/00—Filling or capping teeth
    • A61C5/40—Implements for surgical treatment of the roots or nerves of the teeth; Nerve needles; Methods or instruments for medication of the roots
    • A61C5/44—Means for controlling working depth, e.g. supports or boxes with depth-gauging means, stop positioners or files with adjustably-mounted handles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C5/00—Filling or capping teeth
    • A61C5/40—Implements for surgical treatment of the roots or nerves of the teeth; Nerve needles; Methods or instruments for medication of the roots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C17/00—Devices for cleaning, polishing, rinsing or drying teeth, teeth cavities or prostheses; Saliva removers; Dental appliances for receiving spittle
    • A61C17/16—Power-driven cleaning or polishing devices
    • A61C17/20—Power-driven cleaning or polishing devices using ultrasonics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C5/00—Filling or capping teeth
    • A61C5/50—Implements for filling root canals; Methods or instruments for medication of tooth nerve channels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C17/00—Devices for cleaning, polishing, rinsing or drying teeth, teeth cavities or prostheses; Saliva removers; Dental appliances for receiving spittle
    • A61C17/02—Rinsing or air-blowing devices, e.g. using fluid jets or comprising liquid medication
    • A61C17/0208—Rinsing or air-blowing devices, e.g. using fluid jets or comprising liquid medication combined with means providing suction

Definitions

  • the present disclosure relates generally to dentistry and endodontics and to apparatus, methods, and compositions for treating a tooth.
  • US 2009/042171 A1 discloses electromagnetic radiation procedural devices and, more particularly, the use of such electromagnetic radiation devices in medical applications, such as dental and endodontic procedures.
  • an apparatus for treating a tooth.
  • the apparatus comprises a fluid retainer configured to be applied to the tooth to substantially retain fluid in a tooth chamber in the tooth and a pressure wave generator having a distal portion.
  • the distal portion is configured to be inserted through the fluid retainer into the tooth chamber.
  • the fluid retainer includes a handpiece by which a dental practitioner can apply or maneuver the fluid retainer relative to the tooth during treatment.
  • the pressure wave generator provides an electromagnetic beam of radiation, preferably a laser beam, which electromagnetic beam propagates energy into the tooth chamber.
  • the electromagnetic beam energy can be transformed into pressure waves as it enters the treatment fluid.
  • the electromagnetic beam generates pressure waves which pressure waves generate photo-induced or photo-acoustic cavitation effects in the fluid.
  • the pressure wave generator is configured to be coupled to the handpiece.
  • the apparatus can include a fluid platform configured to substantially retain fluid in a tooth chamber during treatment.
  • the fluid platform can help maintain fluid circulation in the tooth chamber as fluid flows into and out of the tooth chamber.
  • the fluid platform can regulate pressures within a tooth chamber in a tooth.
  • the fluid platform can include one or move vents that permit fluid to leave the tooth (e.g., to inhibit over-pressurization or under-pressurization of the tooth chamber) and/or can inhibit air from flowing into the tooth chamber (which can inhibit generation of pressure waves or acoustic cavitation in fluid in the tooth chamber).
  • the fluid platform promotes fluid circulation in the tooth chamber by retaining fluid (and fluid momentum) in the tooth chamber.
  • the apparatus can include a pressure wave generator configured to generate acoustic waves that can be used for cleaning root canals and tooth surfaces in the tooth chamber.
  • the pressure wave generator can include one or more of a liquid jet device, a waveguide that propagates light energy into a tooth chamber, an ultrasonic device, or a mechanical stirrer.
  • the fluid can include antiseptic or antibacterial solutions to assist in tooth cleaning.
  • the fluid may be degassed to have a reduced dissolved gas content (compared to non-degassed fluids used in endodontic treatments), which may improve the effectiveness of the pressure wave generation or the cleaning.
  • One embodiment can include a fluid platform and a pressure wave generator.
  • the present disclosure describes apparatus, methods, and compositions for performing dental procedures such as, e.g., endodontic procedures.
  • the disclosed apparatus, methods, and compositions advantageously may be used with root canal cleaning treatments, for example, to efficiently remove organic and/or inorganic matter from a root canal system and/or to disinfect the root canal system.
  • the apparatus, methods, and compositions may be used for other dental treatments such as, e.g., tooth cleaning, treatment of dental caries, removal of calculus and plaque, etc.
  • Organic material includes organic substances typically found in healthy or diseased teeth or root canal systems such as, for example, soft tissue, pulp, blood vessels, nerves, connective tissue, cellular matter, pus, and microorganisms, whether living, inflamed, infected, diseased, necrotic, or decomposed.
  • Inorganic matter includes calcified tissue and calcified structures, which are frequently present in the root canal system.
  • FIGURE 1 is a cross section schematically illustrating an example of a typical human tooth 10, which comprises a crown 12 extending above the gum tissue 14 and at least one root 16 set into a socket (alveolus) within the jaw bone 18.
  • a typical human tooth 10 which comprises a crown 12 extending above the gum tissue 14 and at least one root 16 set into a socket (alveolus) within the jaw bone 18.
  • the tooth 10 schematically depicted in FIGURE 1 is a molar
  • the apparatus and methods described herein may be used on any type of human or animal tooth such as an incisor, a canine, a bicuspid, a pre-molar, or a molar.
  • a pulp cavity 26 is defined within the dentin 20.
  • the pulp cavity 26 comprises a pulp chamber 28 in the crown 12 and a root canal space 30 extending toward an apex 32 of each root 16.
  • the pulp cavity 26 contains dental pulp, which is a soft, vascular tissue comprising nerves, blood vessels, connective tissue, odontoblasts, and other tissue and cellular components.
  • the pulp provides innervation and sustenance to the tooth 10 through the epithelial lining of the pulp chamber 28 and the root canal space 30. Blood vessels and nerves enter/exit the root canal space 30 through a tiny opening, the apical foramen 34, near a tip of the apex 32 of the root 16.
  • FIGURE 2A schematically illustrates an example of a system for treating a tooth 10 with a pressure wave generator 64.
  • An endodontic access opening is formed into the tooth 10, for example, on an occlusal surface, a buccal surface, or a lingual surface.
  • the access opening provides access to a portion of the pulp cavity 26 of the tooth 10.
  • the system can include a fluid retainer 66 and the pressure wave generator 64.
  • the pressure wave generator 64 is electrically connected to a source of electrical power by an electrical lead 62.
  • the fluid retainer 66 can comprise a cap 70 and a flow restrictor 68 that inhibits flow of fluid from the tooth 10.
  • the flow restrictor 68 may also inhibit flow of air into the tooth 10.
  • the cap 70 may be formed from a sufficiently durable, biocompatible substance such as metal or plastic.
  • the flow restrictor 68 may include a sponge, a membrane (permeable or semi-permeable), or a vent. The flow restrictor 68 may limit fluid pressure in the tooth 10 such that if the fluid pressure rises above a threshold, fluid can leak or flow from the tooth chamber through the flow restrictor 68.
  • Fluids as described herein generally means liquids, and the liquids may include a certain amount of dissolved gas.
  • a fluid can include water (having a normal dissolved gas (e.g., air) content as can be determined from Henry's law for the appropriate temperature and pressure conditions) or degassed water, which can have a reduced dissolved gas content as compared to water with a normal dissolved gas content.
  • the fluid retainer 66 may include a handpiece (not shown) by which a dental practitioner can apply or maneuver the fluid retainer 66 relative to the tooth 10 during treatment.
  • the fluid retainer 66 can be applied to the tooth with a mechanical clasp or clamp (see, e.g., FIGS. 10A and 10B ), a dental adhesive, or by pressure applied by the patient by biting on the retainer (see, e.g., FIG. 11 ).
  • the tooth chamber 65 may include at least a portion of the pulp chamber 28 and may also include at least a portion of one or more of the following: an access opening to the tooth, a root canal space 30, and a tubule.
  • the tooth chamber 65 can include some or all of the root canal spaces 30, accessory canals, and tubules in the tooth 10.
  • the access opening is formed apart or separately from the tooth chamber.
  • the distal end of the pressure wave generator 64 may be disposed in the tooth chamber, for example, in the pulp chamber 28.
  • the distal end of the pressure wave generator 64 may be sized or shaped to fit in the tooth chamber.
  • the distal end of the pressure wave generator may be sized to fit in or through an endodontic access opening formed in the tooth.
  • the distal end of the pressure wave generator 64 may be disposed within a few millimeters of the floor of the pulp chamber 28 (see, e.g., FIG. 15C ).
  • the distal end of the pressure wave generator 64 is disposed in the fluid retained by the fluid retainer 66, but outside the pulp cavity 26 (e.g., beyond the occlusal surface of the tooth).
  • the pressure wave generator 64 (in addition to or as an alternative to the fluid retainer 66) may be coupled to a handpiece or portable housing that may be maneuvered in the mouth of the patient so as to position or orient the pressure wave generator 64 relative to a desired tooth under treatment.
  • the distal end of the pressure wave generator 64 may be submerged in fluid in the tooth chamber during at least a portion of the endodontic procedure.
  • the distal end of the pressure wave generator 64 is disposed in the tooth chamber 65 while there is little or not liquid in the tooth chamber. Fluid can be added to the tooth chamber such that a fluid level rises above the distal end of the generator 64.
  • the pressure wave generator 64 may then be activated for at least a portion of the endodontic procedure. During other portions of the procedure, the generator 64 is inactive and/or above the fluid level in the tooth chamber 65.
  • the liquid jet device may function as a fluid inlet 71 to the tooth chamber 65 and may deliver fluid to at least partially fill the chamber. Accordingly, in some such embodiments, the liquid jet device functions as a pressure wave generator 64 and as a fluid inlet 71.
  • the pressure wave generator 64 is configured to generate an acoustic wave 67 that can propagate through the tooth and/or the fluid in the tooth chamber 65 and can detach or dissolve organic and/or inorganic material from dentinal surfaces and/or dissociate pulpal tissue.
  • the fluid in the tooth chamber 65 can act as a propagation medium for the acoustic wave 67 and can help propagate the acoustic wave 67 toward the apex 32 of the root canal space 30, into tubules, and into other spaces in the tooth where organic matter may be found.
  • the acoustic wave 67 may cause or increase the efficacy of various effects that may occur in the tooth 10 including, but not limited to, acoustic cavitation (e.g., cavitation bubble formation and collapse, inertial cavitation, microjet formation), acoustic streaming, microerosion, fluid agitation, fluid circulation, vorticity, sonoporation, sonochemistry, and so forth.
  • acoustic cavitation e.g., cavitation bubble formation and collapse, inertial cavitation, microjet formation
  • the acoustic energy may be sufficient to cause organic and/or inorganic material in the tooth to be detached from surrounding dentin.
  • the effects caused (or enhanced) by the acoustic energy may lead to a cleaning action that delaminates or detaches the pulpal tissue from the root canal wall, dentinal surfaces, and/or tubules, and may further break such tissue down into smaller pieces.
  • the acoustic field generated by the pressure wave generator 64 may generate a cavitation cloud within the fluid retained in the tooth chamber 65.
  • the creation and collapse of the cavitation cloud (and/or the jet impacting the impingement surface) may, in some cases, generate a substantial hydroacoustic field in the tooth 10.
  • This acoustic field may generate pressure waves, oscillations, and/or vibrations in or near the canal spaces of the tooth and/or interior dentinal surfaces, which are filled with dentinal tubules.
  • cavitation effects may be possible, including growth, oscillation, and collapse of cavitation bubbles formed in or near the tubules (e.g., possibly at the high surface-energy sites of the tubules). These (and/or other) effects may lead to efficient cleaning of the pulp chamber 28 of the tooth.
  • FIGURES 2B-1 and 2B-2 are graphs that schematically illustrate possible examples of acoustic power that could be generated by different embodiments of the pressure wave generator. These graphs schematically show acoustic power (in arbitrary units) on the vertical axis as a function of acoustic frequency (in kHz) on the horizontal axis.
  • the acoustic power in the tooth may influence, cause, or increase the strength of effects including, e.g., acoustic cavitation (e.g., cavitation bubble formation and collapse, microjet formation), acoustic streaming, microerosion, fluid agitation, fluid circulation, sonoporation, sonochemistry, and so forth, which may act to dissociate organic material in the tooth 10 and effectively clean the pulp cavity 26 and/or the canal spaces 30.
  • acoustic cavitation e.g., cavitation bubble formation and collapse, microjet formation
  • acoustic streaming e.g., acoustic streaming, microerosion, fluid agitation, fluid circulation, sonoporation, sonochemistry, and so forth, which may act to dissociate organic material in the tooth 10 and effectively clean the pulp cavity 26 and/or the canal spaces 30.
  • the pressure wave generator 64 may produce an acoustic wave 67 including acoustic power (at least) at frequencies above: about 0.5 kHz, about 1 kHz, about 10 kHz, about 20 kHz, about 50 kHz, about 100 kHz, or greater.
  • the acoustic wave 67 may have acoustic power at other frequencies as well (e.g., at frequencies below the aforelisted frequencies).
  • the graph in FIGURE 2B-1 represents a schematic example of acoustic power generated by a liquid jet impacting a surface disposed in a tooth chamber 65 and by the interaction of the liquid jet with fluid in the tooth chamber.
  • This schematic example shows a broadband spectrum 190 of acoustic power with significant power extending from about 1 kHz to about 1000 kHz (e.g., the bandwidth may about 1000 kHz).
  • the bandwidth of the acoustic energy spectrum may, in some cases, be measured in terms of the 3-decibel (3-dB) bandwidth (e.g., the full-width at half-maximum or FWHM of the acoustic power spectrum).
  • a broadband acoustic power spectrum may include significant power in a bandwidth in a range from about 1 kHz to about 500 kHz, in a range from about 10 kHz to about 100 kHz, or some other range of frequencies.
  • a broadband spectrum may include acoustic power above about 1 MHz.
  • the pressure wave generator 64 can produce broadband acoustic power with peak power at about 10 kHz and a bandwidth of about 100 kHz.
  • the bandwidth of a broadband acoustic power spectrum is greater than about 10 kHz, greater than about 50 kHz, greater than about 100 kHz, greater than about 250 kHz, greater than about 500 kHz, greater than about 1 MHz, or some other value.
  • acoustic power between about 20 kHz and 200 kHz is particularly effective.
  • the acoustic power may have substantial power at frequencies greater than about 1 kHz, greater than about 10 kHz, greater than about 100 kHz, or greater than about 500 kHz.
  • Substantial power can include, for example, an amount of power that is greater than 10%, greater than 25%, greater than 35%, or greater than 50% of the total acoustic power (e.g., the acoustic power integrated over all frequencies).
  • the graph in FIGURE 2B-2 represents a schematic example of acoustic power generated by an ultrasonic transducer disposed in a tooth chamber 65.
  • This schematic example shows a relatively narrowband spectrum 192 of acoustic power with a highest peak 192a near the fundamental frequency of about 30 kHz and also shows peaks 192b near the first few harmonic frequencies.
  • the bandwidth of the acoustic power near the peak is about 5 to 10 kHz, and can be seen to be much narrower than the bandwidth of the acoustic power schematically illustrated in FIGURE 2B-1 .
  • the bandwidth of the acoustic power can be about 1 kHz, about 5 kHz, about 10 kHz, about 20 kHz, about 50 kHz, about 100 kHz, or some other value.
  • the acoustic power of the example spectrum 192 has most of its power at the fundamental frequency and first few harmonics, and therefore the ultrasonic transducer of this example may provide acoustic power at a relatively narrow range of frequencies (e.g., near the fundamental and harmonic frequencies).
  • the acoustic power of the example spectrum 190 exhibits relatively broadband power (with a relatively high bandwidth compared to the spectrum 192), and the example liquid jet may provide acoustic power at significantly more frequencies than the example ultrasonic transducer.
  • acoustic waves having broadband acoustic power may generate cavitation that is more effective at cleaning teeth than cavitation generated by acoustic waves having a narrowband acoustic power spectrum (see, e.g., the example shown in FIG. 2B-2 ).
  • a broadband spectrum of acoustic power may produce a relatively broad range of bubble sizes in the cavitation cloud, and the implosion of these bubbles is more effective at disrupting tissue than bubbles having a narrow size range.
  • Relatively broadband acoustic power may also allow acoustic energy to work on a range of length scales, e.g., from the cellular scale up to the tissue scale.
  • pressure wave generators that produce a broadband acoustic power spectrum e.g., some embodiments of a liquid jet
  • multiple narrowband pressure wave generators are used to produce a relatively broad range of acoustic power. For example, multiple ultrasonic tips, each tuned to produce acoustic power at a different peak frequency, are used.
  • Some apparatus and methods disclosed herein may perform more efficiently if at least a portion of the pulp cavity 26 of the tooth 10 under treatment is filled with fluid (e.g., liquid) during an endodontic procedure.
  • the pulp chamber 28 is substantially filled with liquid with substantially no air (or gas) pockets remaining in the pulp chamber 28.
  • leakage of air into the pulp chamber 28 may reduce the effectiveness of the treatment in some circumstances (e.g., by reducing the effectiveness of cavitation and damping the pressure waves).
  • leakage of the fluid from the pulp chamber 28 into the oral cavity e.g., mouth
  • the oral cavity e.g., mouth
  • leakage of the fluid from the pulp chamber 28 into the oral cavity is not desired as such leakage may leave an unpleasant taste or smell or may lead to damaged tissues in the patient's mouth.
  • a fluid platform that maintains a substantially liquid-filled pulp chamber 28, inhibits leakage of air into the pulp chamber 28 during treatment, and/or inhibits leakage of treatment fluid, waste fluid, and/or material from the pulp cavity into the mouth of the patient.
  • the fluid platform 61 (e.g., a fluid retainer) is used for maintaining fluid in a tooth chamber 65 in a tooth, which may advantageously enable cleaning of a root canal space 30 (or other portions of the tooth.
  • fluid is delivered to the tooth chamber 65, and the fluid pressure in the tooth chamber 65 may rise. If the fluid pressure in the chamber becomes too great, organic material, fluid, etc. is forced through the apex 32 of the tooth 10, which may lead to complications such as infection. Also, if for example due to suction negative pressure is created inside the tooth chamber, and if the absolute magnitude of the negative pressure is large enough, the negative pressure may cause problems such as pain and discomfort for the patient.
  • the fluid platform 61 is configured such that the pressure created at the apex 32 of the tooth 10 (or in a portion of the tooth chamber such as, e.g., the pulp chamber 28) is below an upper value of: about 500 mmHg, about 300 mmHg, about 200 mmHg, about 100 mmHg, about 50 mmHg, about 30 mmHg, about 20 mmHg, or some other value.
  • 1 mmHg is one millimeter of mercury and is a measure of pressure equal to about 133.322 Pascal).
  • Embodiments of the fluid platform is configured so that if the fluid pressure in the tooth chamber 65 rises above an upper threshold, fluid can flow or leak from the chamber to maintain the fluid pressure at a safe or desired level.
  • the threshold can be a predetermined pressure level. Certain predetermined pressure levels are about 500 mmHg, about 300 mmHg, about 200 mmHg, about 100 mmHg, about 50 mmHg, about 30 mmHg, or about 20 mmHg.
  • the apical pressure or tooth chamber pressure be greater than a lower value of: about -1000 mmHg, about -500 mmHg, about -300 mmHg, about -200 mmHg, about -100 mmHg, about -50 mmHg, about 0 mmHg, or some other value.
  • a flow restrictor e.g., a sponge or vent
  • the lower threshold can be a predetermined pressure level. Certain predetermined pressure levels are about -1000 mmHg, about -500 mmHg, about -300 mmHg, about -200 mmHg, about -100 mmHg, about -50 mmHg, about or 0 mmHg.
  • various embodiments of the fluid retainer can self-regulate the pressure in the tooth chamber to be below a first (e.g., upper) threshold and/or above a second (e.g., lower) threshold.
  • either or both thresholds can be a predetermined pressure level.
  • the fluid pressure in the tooth chamber 65 may fluctuate with time as fluid flows in and out of the chamber and/or as a pressure wave generator 64 is activated to generate acoustic waves 67 (which comprise pressure oscillations).
  • the acoustic waves 67 may induce cavitation, which can cause pressure fluctuations as well.
  • a mean or average pressure is used.
  • the mean pressure is a time average of the pressure (at a particular point in the fluid) over a time period corresponding to the pressure fluctuations occurring in the fluid, or in some contexts, a spatial average of the pressure over a spatial region (e.g., over some or all of the tooth chamber).
  • the pressure at a given point is much larger than the mean pressure (e.g., due to a cavitation-induced event), and certain embodiments of the fluid platform may provide safety features to inhibit the rise of pressure above an undesired or unsafe threshold (e.g., by providing a vent to allow liquid to flow from the tooth chamber).
  • the tooth chamber 65 (e.g., a portion of the pulp cavity) is substantially open to ambient air, fluids, etc., and the fluid inside the tooth chamber 65 may not be fully contained in the tooth chamber 65.
  • the fluid may splash, overflow, or be evacuated via an external system (e.g., a suction wand) during the dental procedure.
  • the fluid is replenished intermittently or continuously during the procedure (e.g., via irrigation or syringing).
  • the excess waste fluid also may be evacuated from the patient's mouth or from a rubber dam (if used) intermittently or continuously during the procedure.
  • An example of an uncontrolled method of fluid management is the irrigation of the root canals with endodontic irrigation syringes. During this procedure, the fluid is injected into and exits from the pulp cavity, flowing into the oral space or a rubber dam (if used) and/or is suctioned by an external evacuation system operated by dental assistant.
  • Another example of uncontrolled fluid management is activation of the irrigation fluid by ultrasonic tips that can be inserted into the root canals. Upon activation of the ultrasonic device, the fluid in the tooth may splash out of the pulp cavity.
  • the fluid inside the pulp cavity can be replenished via a syringe or the waterline of the ultrasonic tip, and the excess fluid is suctioned from the oral space or the rubber dam (if used) via an external suction hose operated by a dental assistant.
  • Another type of fluid platform is categorized as a "controlled" fluid platform.
  • the fluid is substantially contained in the tooth chamber 65 (e.g., pulp cavity) by using an apparatus to at least partially cover an endodontic access opening.
  • Some such fluid platforms may or may not include fluid inlets and/or outlets for the fluid to enter and exit the tooth chamber 65, respectively.
  • Fluid flowing in and/or out of the tooth 10 during a procedure can be controlled.
  • the total volume (or rate) of fluid going into the tooth 10 is controlled to be substantially equal to the total volume (or rate) of fluid going out of the tooth 10. Examples of two types of controlled fluid platforms will be described.
  • a closed system can be a controlled system where the amount of fluid flowing into the tooth chamber 65 substantially equals the amount of fluid exiting the tooth chamber 65.
  • An example of a closed system includes a fluid cap 70 that is applied or sealed to the tooth 10, around the endodontic opening.
  • the fluid's driving force e.g., a pressure differential
  • the fluid's driving force is applied to only one of the openings (e.g., either inlet or outlet).
  • the driving force can be applied at both the inlet and the outlet, in which case the applied driving forces is regulated to be substantially equal in magnitude in order to reduce or avoid the following possible problems: exerting pressure (positive or negative) onto the tooth 10 which may result in extrusion of fluid/debris periapically (e.g., positive pressure) or causing pain and/or bleeding due to excessive negative pressure, or breaking the seal of the fluid platform causing leakage of fluid and organic matter into the mouth (e.g., positive pressure) or drawing air into the chamber (e.g., negative pressure) which can reduce the treatment efficiency.
  • pressure positive or negative
  • the applied driving forces is regulated to be substantially equal in magnitude in order to reduce or avoid the following possible problems: exerting pressure (positive or negative) onto the tooth 10 which may result in extrusion of fluid/debris periapically (e.g., positive pressure) or causing pain and/or bleeding due to excessive negative pressure, or breaking the seal of the fluid platform causing leakage of fluid and organic matter into the mouth (e.
  • Some closed fluid platforms are relatively sensitive due to the regulation of the inlet and outlet fluid pressures to be substantially the same. Some such closed systems may lead to safety issues for the patient. For example, some such implementations may not ensure a substantially safe pressure that the patient's body can tolerate (e.g., apical pressures in a range from about -30 mmHg to +15 mmHg, or -100 mmHg to +50 mmHg, or -500 mmHg to +200 mmHg, in various cases). Some such closed systems can result in exertion of pressure (negative or positive) inside the tooth.
  • a small obstruction on the outlet fluid line (which inhibits or reduces outflow of fluid from the tooth chamber) can result in increased pressure inside the tooth 10.
  • the elevation at which the waste fluid is discharged with respect to the tooth can cause static pressures inside the tooth 10.
  • Examples of a vented fluid platform include controlled systems where the inlet fluid flow rate and exit fluid flow rate may, but need not be, substantially the same. The two flow rates may in some cases, or for some time periods, be substantially the same.
  • the fluid platform may include one or more "vents" that permit fluid to leave the tooth chamber 65, which can reduce the likelihood of an unsafe or undesired increase in fluid pressure (e.g., pressure at the periapical region).
  • the inlet and outlet flow rates are driven by independent driving forces.
  • the fluid inlet is in fluid communication with and driven by a pressure pump, while a fluid outlet is in fluid communication with and controlled via an evacuation system (e.g., a suction or vacuum pump).
  • the fluid inlet or outlet is controlled with a syringe pump.
  • the pressures of the fluid inlet and the fluid outlet are such that a negative net pressure is maintained in the tooth chamber 65.
  • Such a net negative pressure may assist delivering the treatment fluid into the tooth chamber 65 from the fluid inlet.
  • the "vents” can take the form of a permeable or semi-permeable material (e.g., a sponge), openings, pores, or holes, etc.
  • a permeable or semi-permeable material e.g., a sponge
  • the use of vents in a controlled fluid platform may lead to one or more desirable advantages.
  • the evacuation system can collect waste fluid from the tooth chamber 65, as long as there is any available. If there is a pause in treatment (e.g. the time between treatment cycles), waste fluid flow may stop, and the evacuation system may start drawing air through the one or more vents to at least partially compensate for the lack of fluid supplied to the evacuation system, rather than depressurizing the tooth chamber 65.
  • vent(s) can tend to dampen the effects of the applied pressure differential, and therefore may inhibit or prevent negative or positive pressure buildup inside the tooth.
  • Certain embodiments of vented fluid platforms may provide increased safety since the system is configured to maintain a safe operating pressure in the tooth, even when the operating parameters deviate from those specified.
  • positive or negative pressure inside the tooth chamber 65 can exert some amount of force on the sealing material(s), and as such a stronger seal is required to withstand such force in some cases.
  • Possible advantages of some vented systems include that the vent(s) help relieve pressure increases (or decreases) inside the tooth, reduce or eliminate the forces acting on the sealing material(s), and therefore render the sealing more feasible and effective.
  • FIGURE 3 A schematically illustrates an example of a fluid platform 61 that is used in an endodontic procedure.
  • the fluid platform 61 includes a fluid retainer 66 (e.g., cap 70 and flow restrictor 68) that is generally similar to those described with reference to FIGURE 2A .
  • the fluid retainer 66 is used to retain fluid in a chamber in the tooth 10.
  • the fluid retainer 66 may include an internal (or inner) chamber 69 such that when the fluid retainer 66 is applied to the tooth, the internal chamber 69 and the tooth chamber 65 together form a fluid chamber 63.
  • the fluid chamber 63 is at least partially filled with fluid.
  • the fluid chamber 63 is substantially or completely filled with fluid during a treatment procedure.
  • the flow restrictor 68 which can function as the vent described above, is used to permit fluid to flow from the chamber 63 (e.g., if the fluid pressure in the chamber becomes too large) and/or to inhibit flow of air into the chamber 63.
  • the flow restrictor 68 can help retain fluid in the tooth chamber which may assist promoting fluid circulation in the tooth chamber, which may increase the effectiveness of irrigation or cleaning.
  • the flow restrictor 68 can comprise a sponge (e.g., an open-cell or closed-cell foam) in some embodiments.
  • An example of a flow restrictor 68 comprising an opening or port in the fluid platform 61 will be described with reference to FIGURE 3B .
  • the fluid platform 61 also can include a fluid inlet 71 for delivering fluid to the chamber 63 in the tooth 10.
  • the fluid inlet 71 can have a distal end that is configured to be submerged in the fluid in the chamber 63 (after the chamber substantially fills with fluid).
  • the distal end of the fluid inlet 71 is sized and shaped so that it is disposed in the pulp chamber 28 of the tooth 10, for example as shown in FIGURE 3 A .
  • the distal end of the inlet 71 is disposed within the pulp chamber 28 and above the entrances to the root canal spaces 30. Thus, in some such implementations, the fluid inlet 71 does not extend into the canal spaces.
  • the distal end of the inlet 71 is disposed in the fluid retained by the fluid retainer 66, but outside the pulp cavity 26 (e.g., above the occlusal surface of the tooth).
  • the distal end of the fluid inlet 71 is sized/shaped to fit in a portion of a root canal space 30.
  • the distal end of the inlet 71 may comprise a thin tube or needle.
  • the inlet 71 comprises a hollow tube, lumen, or channel that delivers the fluid to the tooth chamber 65.
  • the fluid inlet 71 is a liquid beam (e.g., a high-velocity liquid jet) that is directed into the tooth chamber 65.
  • the liquid beam may deliver fluid to the tooth chamber 65 as well as generate pressure waves 67 in the fluid in the chamber 63.
  • the fluid platform 61 can include a fluid introducer configured to supply fluid from a liquid source to the tooth chamber.
  • the fluid introducer may comprise embodiments of the fluid inlet 71.
  • the fluid introducer can also include a fluid line (or tubing) that provides fluidic communication between the fluid introducer and the liquid source.
  • the fluid introducer may include a portion of a liquid jet device in some implementations.
  • the fluid inlet 71 is in fluid communication with a fluid reservoir, supply, or source that provides the fluid to be delivered to the tooth via the inlet 71.
  • the fluid is delivered under pressure, for example, by use of one or more pumps or by using a gravity feed (e.g., by raising the height of the fluid reservoir above the height of the tooth chamber 65).
  • the fluid platform 61 may include additional components (not shown in FIG. 3A ) including, e.g., pressure regulators, pressure sensors, valves, etc.
  • a pressure sensor is disposed in a tooth chamber 65, to measure the pressure in the tooth chamber 65 during treatment.
  • the flow of fluid from the inlet 71 may cause or augment fluid movement in the tooth chamber 65.
  • the flow that is generated may cause (or augment) circulation, agitation, turbulence, etc. in the tooth chamber 65, which may improve irrigation or cleaning effectiveness in some cases.
  • a liquid jet device is used to function as the inlet 71 and can deliver fluid to the tooth chamber 65 as well as generate pressure waves 67 in the chamber 65.
  • the liquid jet device can serve as the pressure wave generator 64 and the fluid inlet 71 in such implementations.
  • the fluid from the liquid jet (as well as its conversion to a spray if an impingement plate is used) can induce circulation in the tooth chamber 65.
  • the flow of fluid from the inlet 71 is used for a number of processes such as irrigation, cleaning, or disinfecting the tooth.
  • FIGURE 3B schematically illustrates another example of a fluid platform 61 that is used in an endodontic procedure.
  • the fluid platform 61 comprises the fluid retainer 66, the fluid inlet 71, and a fluid outlet 72 configured to remove fluid from the tooth chamber 65.
  • the fluid retainer 66 comprises the cap 70 that is applied or attached to a tooth seal formed on the tooth (a tooth seal 75 will be described below with reference to FIGS. 13B and 13C ).
  • An (optional) flow restrictor 68 comprising elastic material (e.g., a sponge or semi-permeable material) is disposed within the gap to assist in providing a substantially water tight seal between the cap 70 and the tooth seal 75.
  • the substantially water tight seal helps retain fluid within the tooth chamber 65 during treatment and may also inhibit ambient air from entering the tooth chamber 65 during treatment.
  • the fluid outlet 72 functions passively, for example, the fluid moves through the outlet 72 because of capillary forces, gravity, or a slight overpressure created in the tooth.
  • the fluid outlet 72 is actively pumped, and the fluid can be transferred using a pump, suction, or other device that draws fluid out through the outflow conduit.
  • the fluid outlet 72 comprises a suction line operated under partial vacuum pressure to suction out fluid and is connected to the suction system/vacuum lines commonly found in a dental office.
  • fluid is at least partially retained in the fluid chamber 63, which can comprise the internal chamber 69 in the fluid retainer 66 and the tooth chamber 65.
  • the fluid chamber 63 is at least partially filled with fluid.
  • the fluid chamber 63 is substantially or completely filled with fluid during a treatment procedure.
  • the fluid inlet 71 and the fluid outlet 72 are in fluid communication with fluid retained in the fluid chamber 63.
  • both the fluid inlet 71 and the fluid outlet 72 are in fluid communication with the fluid in the fluid chamber 63, and fluid can flow into the tooth from the fluid inlet 71 (solid arrowed lines 92a in FIG.
  • the fluid platform 61 comprises an additional flow restrictor in the form of a vent 73 that is disposed along the fluid outlet 72.
  • the vent 73 can permit fluid from the tooth chamber 65 to flow out of the vent 73, for example if the fluid pressure becomes too large in the chamber.
  • the vent 73 can act as a relief valve to inhibit over-pressurization of the tooth chamber 65.
  • the vent 73 comprises a directionally biased valve that permits fluid to leave the tooth chamber 65 but inhibits ambient air from entering the tooth chamber 65.
  • the vent 73 may comprise one or more one-way (or check) valves.
  • a one-way valve may have a cracking pressure selected to permit fluid to leave the tooth chamber 65 when the fluid pressure in the tooth chamber 65 exceeds a pressure threshold (e.g., about 100 mmHg in some cases).
  • a one-way valve is used to permit ambient air to flow into the tooth chamber 65 when the pressure differential between ambient conditions and the pressure in the tooth chamber 65 is sufficiently large.
  • the cracking pressure of such a one-way valve is selected such that if the fluid pressure in the chamber is less than a net (negative) threshold (e.g., the tooth chamber is under-pressurized), the valve will open to permit ambient air to flow into the fluid retainer 66.
  • a net (negative) threshold e.g., the tooth chamber is under-pressurized
  • the vents 73 comprise a one-way valve to permit fluid to leave the fluid retainer 66 (while inhibiting ambient air from entering), and a one-way valve to permit ambient air to enter the fluid retainer 66.
  • the cracking pressures of these two one-way valves are selected so that in a desired pressure range, fluid is retained in the tooth chamber 65 and ambient air is inhibited from entering the tooth chamber 65.
  • the pressure range in the tooth is between about -100 mmHg and +100 mmHg.
  • the vent 73 is configured to permit air to enter the fluid outlet 72 and be entrained with fluid removed from the tooth chamber 65.
  • the vent 73 is positioned and oriented such that ambient air flows into the fluid outlet 72 in the direction of the fluid flow in the outlet 72 (see, e.g., dashed arrowed line 94a).
  • the flow in the fluid outlet 72 includes both fluid from the tooth chamber 65 (see, e.g., solid arrowed line 92b) and ambient air (see, e.g., dashed arrowed line 94b).
  • the vent 73 is disposed near the entry point of fluid into the outlet 72, e.g., within a few millimeters, which may make it easier for fluid to flow from the tooth chamber 65 if the pressure therein rises too high.
  • a plurality of vents 73 are used such as, two, three, four, or more vents.
  • the vents 73 are sized, shaped, positioned, and/or oriented to allow fluid to flow from the tooth chamber 65 while inhibiting air from entering the tooth chamber 65.
  • the example systems shown in FIGURES 3A and 3B can assist in inducing fluid circulation in the tooth chamber 65 due to the inflow of fluid from the fluid inlet 71 and/or the removal of fluid from the fluid outlet 72 (if present).
  • the example systems may also advantageously have patient safety features. For example, if the fluid outlet 72 is blocked (e.g., a suction tube is kinked or the suction ceases to function), the flow of fluid into the tooth chamber 65 from the inlet 71 can lead to increasing fluid pressures, which can lead to the level of fluid rising up into the outlet 72.
  • the flow restrictor 68 (e.g., a sponge or a vent) can relieve the fluid pressure by allowing fluid to leave the tooth chamber 65 (e.g., by flowing through the sponge or leaking out the vent).
  • the fluid outlet 72 may remove the fluid from the tooth chamber 65 and may lead to increasingly lower pressures in the tooth chamber 65.
  • the flow restrictor 68 can tend to keep the pressure in the tooth 10 at a safe or desirable level by allowing ambient air to flow into the fluid outlet 72 to at least partially alleviate the depressurization of the tooth chamber 65.
  • certain such embodiments may provide advantages over closed fluid containers that do not include some form of fluid restrictor or pressure relief valve.
  • certain embodiments of the fluid platform 61 is at least partially open to the ambient environment (e.g., via the flow restrictor 68) and may substantially allow the pressure in the tooth chamber 65 to self-regulate.
  • An additional advantage of certain such embodiments is that pressure regulators, pressure sensors, inlet/outlet control valves, etc. need not be used to monitor or regulate the pressure in the tooth chamber 65 under treatment, because the selfregulation of the flow restrictor 68 permits the pressure to remain within desired or safe levels.
  • pressure regulators, pressure sensors, and control valves are used to provide additional control over the fluid environment in the tooth.
  • pressure sensor(s) could be used to measure pressure along a fluid inlet 71 or a fluid outlet 72, in a portion of the tooth chamber 65, etc.
  • a temperature sensor or temperature controller is used to monitor or regulate the temperature of the fluid in the fluid inlet 71 or a fluid outlet 72, in the tooth chamber 65, etc.
  • Substantially anything cleaned out from the pulpal chamber (in teeth that have pulpal chambers) and canals of a tooth (including pulp, debris, organic matter, calcified structures, etc.) are monitored to determine the extent or progress of the tooth cleaning or to determine when the tooth becomes substantially clean. For example, when substantially no more pulp, calcified structures, organic matter, inorganic matter, and/or debris comes out of the tooth, the tooth is substantially clean, and the system may provide a signal (e.g., audible/visible alarm, appropriate output on a display monitor) to the operator to stop the procedure.
  • a signal e.g., audible/visible alarm, appropriate output on a display monitor
  • Such monitoring of the output from the tooth chamber 65 is used with any of the embodiments described herein, including with open, closed, or vented fluid platforms.
  • FIGURE 3C schematically illustrates an example of a fluid platform 61 in which the fluid outlet 72 is in fluid communication with an optional monitoring sensor 74.
  • the monitoring sensor 74 can monitor or analyze one or more properties of the fluid removed from the tooth 10.
  • the monitoring sensor 74 can include an optical, electrical (e.g., resistive), chemical, and/or electrochemical sensor.
  • Monitoring sensors 74 can include a liquid particle counter (e.g., configured to determine a range of particle sizes in the fluid), a liquid or gas chromatograph, a flame ionization detector, photoionization detector, a thermal conductivity detector, a mass spectrometer, etc.
  • the monitoring sensor 74 can use elemental analysis techniques to determine properties of the fluid.
  • the fluid from the tooth may contain substantial amounts of pulpal matter such that the fluid is murky and reflects, and does not transmit, much light.
  • the amount of pulpal matter in the fluid decreases, and the reflectivity may correspondingly decrease (or the transmittivity may increase).
  • the fluid in the outlet 72 is substantially clear, and the reflectivity or transmittivity may reach a threshold value appropriate for fluid without pulpal matter (e.g., for clear water). The decrease of pulpal matter in the fluid outflow is used as an indicator that the treatment is substantially complete or that the tooth chamber is substantially clean.
  • a second monitoring sensor 74 is disposed upstream of the fluid platform 61 and can be used to provide a baseline measurement of properties of the fluid prior to entering the tooth chamber 65.
  • the threshold value is based, at least in part, on the baseline measurement.
  • the monitoring is done continuously during the treatment or is done at discrete times during the treatment.
  • the monitoring sensor 74 is configured to measure an amount of carbon in the fluid, e.g., total organic carbon (TOC), total inorganic carbon, or total carbon.
  • the amount of total inorganic carbon may reflect removal of hard structures such as calcified tissues, pulp stone, or dentin (e.g., tertiary dentin) during the treatment.
  • the monitoring sensor 74 may measure a property associated with removal of soft tissue (e.g., pulp, bacteria), hard tissue (e.g., pulp stone or calcified tissue), or both.
  • the system may switch to a different solute (e.g., a decalcifying agent) to begin a different phase of the treatment.
  • a solute e.g., a decalcifying agent
  • feedback from the monitoring sensor 74 is used to adjust a pressure wave generator, for example, by increasing or decreasing the time the generator is activated (or deactivated).
  • a proportional-integral-derivative (PID) controller or a fuzzy logic controller is used to regulate or control aspects of the endodontic treatment.
  • the apical pressure or tooth chamber pressure be above a lower value of about -1000 mmHg, about -500 mmHg, about -300 mmHg, about -200 mmHg, about -100 mmHg, about -50 mmHg, about 0 mmHg, or some other value.
  • fluid restrictors e.g., sponges, vents, etc.
  • the pressure at the apex 32 of the tooth 10 it is beneficial for the pressure at the apex 32 of the tooth 10 to be negative (e.g., lower than the pressure in the apical area).
  • a negative pressure may allow inflamed bacteria, debris, and tissue (such as that found in a periapical lesion) to be suctioned out through the apex 32 of the tooth 10 and out of the mouth. It may be advantageous if the negative pressures created in the apex 32 of the tooth 10 are not too high (in magnitude) as this may induce pain in the patient.
  • the pressure created at the apex 32 of the tooth 10 is above about -1000 mmHg. In another embodiment, the pressure created at the apex 32 of the tooth 10 is above other values such as, e.g., about -600 mmHg, -500 mmHg, - 250 mmHg, or some other value.
  • Embodiments of the fluid platform can allow one or more substances to be added during the procedure and in some implementations, the fluid is automatically removed (e.g., via the fluid outlet). Substance concentration is controlled or varied during procedure. One substance is flushed out before introducing another substance, which may prevent unwanted chemical interactions.
  • the fluid platform is a closed system allow the use of more corrosive substances that may not be beneficial if spilled into the patient's oral environment. Substantially continuous replenishing of substances can help chemical reactions occur and may reduce the requirement for high concentration of such chemicals.
  • a controlled fluid platform is configured for one or more of the following.
  • the fluid platform can allow analysis of fluid leaving the tooth to determine when procedure is complete.
  • the fluid platform can prevent overheating of the tooth (if the pressure wave generator 64 or other components generate heat) by irrigating the tooth chamber 65 with fluid through the fluid inlet 71.
  • the fluid platform can reduce or prevent air (e.g., gas) from being introduced into the tooth chamber 65, which may lower the effectiveness of irrigation, pressure waves, or cavitation.
  • a controlled fluid platform can allow cleaning action/energy to be more effective during a procedure, e.g. fewer losses through mechanisms such as splashing, which removes both fluid mass and fluid momentum from the tooth chamber (which otherwise could provide circulation).
  • the distal end of the pressure wave generator 64 is submerged in fluid in the tooth chamber during at least a portion of the endodontic procedure.
  • the distal end of the pressure wave generator 64 is disposed in the tooth chamber 65 while there is little or not liquid in the tooth chamber. Fluid can be added to the tooth chamber via the fluid inlet 71 such that a fluid level rises above the distal end of the generator 64.
  • the pressure wave generator 64 may then be activated for at least a portion of the endodontic procedure. During other portions of the procedure, the pressure wave generator 64 is inactive and/or disposed above the fluid level in the tooth chamber 65.
  • a tooth seal 75 is applied to a perimeter of a crown 12 of the tooth 10.
  • the tooth seal 75 is formed from a substantially pliable or semi-flexible material that sets in a relatively short time by itself or with curing.
  • the upper surface of the tooth seal 75 is made substantially flat after application and removal of a flat plate to the upper surface (see, e.g. , FIGURES 13B-14B ).
  • the upper surface of the tooth seal 75 advantageously may provide a substantially flat working surface upon which the cap 70 of the fluid retainer 66 is disposed or attached so that fluid in the tooth chamber 65 is inhibited from leaking out.
  • FIGURE 4B also shows an (optional) elastomeric material disposed under the cap 70, which can help increase the water-tight seal between the cap 70 and the tooth seal 75.
  • FIGURE 4D shows another example system for cleaning a tooth 10 using a pressure wave generator 64.
  • the system includes a handpiece 50 with a distal end 58 that is applied or attached to a tooth seal 75 formed on the tooth 10.
  • the distal end 58 includes the fluid retainer 66 (e.g., the cap 70).
  • the handpiece 50 includes the fluid inlet 71, the fluid outlet 72, and the pressure wave generator 64. Portions of the fluid inlet 71 and the pressure wave generator 64 extend beyond the cap 70 so that they are disposed in the pulp chamber 28.
  • the handpiece 50 shown in FIGURE 4D also includes vents 73 that are in fluid communication with the fluid outlet 72.
  • the vents 73 permit ambient air to be drawn into the fluid outlet 72 and to be entrained with fluid removed from the tooth 10.
  • the vents 73 may help prevent the tooth chamber 65 from being depressurized (e.g., in the event that most of the fluid is withdrawn from the tooth chamber 65), because as the pressure in the tooth chamber 65 decreases, air is drawn in from the vents 73 rather than from the tooth chamber 65.
  • the pressure waves 67 generated in the pulp chamber 28 can also remove calcified tissues and structures (e.g., pulp stones, tertiary dentin, etc.) inside the root canals.
  • the pressure waves 67 generated in the pulp chamber 28 is used to remove smear layer and debris in instrumented canals.
  • the pressure waves 67 generated can reach all or substantially all interior spaces of the tooth, e.g., substantially everything in contact with the fluid, including accessory canals, tubules, etc.
  • the pressure waves 67 can clean the pulp chamber and all canals simultaneously, without requiring entering the root canals. In some treatments, there is no need to find or locate the canals prior to the procedure.
  • a fluid comprising a tissue dissolver can be used during a cleaning phase of the treatment, and an irrigant can be used to flush the cleaned pulp tooth chamber.
  • Combinations of the foregoing (or other) fluids can be used, for example, mixtures of solutions or a sequence of different applied solutions.
  • the type(s) and/or concentration(s) of chemical(s) in the fluid can change during treatment.
  • a treatment solution is water or saline with about 0.3% to about 6% NaOCI.
  • bubbles 96 in the fluid may act as a cushion to damp pressure waves 67 propagating in the region of the fluid comprising the bubbles 96, which may disrupt effective propagation of the pressure waves 67 past the bubbles 96.
  • Some bubbles 96 may either form inside the root canals 30 or be transferred there by the flow or circulation of fluid in the tooth. Once inside the canals 30, the bubbles 96 are hard to remove due to relatively high surface tension forces. This may result in blocking the transfer of chemicals and/or pressure waves into the canals and therefore may disrupt or reduce the efficacy of the treatment.
  • the degassed fluid is able to penetrate spaces as small as about 500 microns, 200 microns, 100 microns, 10 microns, 5 microns, 1 micron, or smaller, because the degassed fluid is sufficiently gas-free that bubbles are inhibited from coming out of solution and blocking these spaces (as compared to use of fluids with normal dissolved gas content).
  • the amount of dissolved gas in the degassed fluid is measured in terms of the amount of dissolved oxygen (rather than the amount of dissolved air), because the amount of dissolved oxygen is more readily measured (e.g., via titration or optical or electrochemical sensors) than the amount of dissolved air in the fluid.
  • a measurement of dissolved oxygen in the fluid may serve as a proxy for the amount of dissolved air in the fluid.
  • the amount of dissolved oxygen in the degassed fluid is in a range from about 1 mg/L to about 3 mg/L, in a range from about 0.5 mg/L to about 7 mg/L, or some other range.
  • the amount of dissolved gas in the degassed fluid is in a range from about 2 mg/L to about 20 mg/L, in a range from about 1 mg/L to about 12 mg/L, or some other range.
  • the amount of dissolved gas in the degassed fluid may be less than about 20 mg/L, less than about 18 mg/L, less than about 15 mg/L, less than about 12 mg/L, less than about 10 mg/L, less than about 8 mg/L, less than about 6 mg/L, less than about 4 mg/L, or less than about 2 mg/L.
  • the amount of dissolved gas in a liquid is measured in terms of a physical property such as, e.g., fluid viscosity or surface tension.
  • a physical property such as, e.g., fluid viscosity or surface tension.
  • degassing water tends to increase its surface tension.
  • the surface tension of non-degassed water is about 72 mN/m at 20 °C. In some embodiments, the surface tension of degassed water is about 1%, 5%, or 10% greater than non-degassed water.
  • degassing units examples include: a Liqui-Cel ® MiniModule ® Membrane Contactor (e.g., models 1.7 x 5.5 or 1.7 x 8.75) available from Membrana-Charlotte (Charlotte, North Carolina); a PermSelect ® silicone membrane module (e.g., model PDMSXA-2500) available from MedArray, Inc. (Ann Arbor, Michigan); and a FiberFlo ® hollow fiber cartridge filter (0.03 micron absolute) available from Mar Cor Purification (Skippack, Pennsylvania).
  • the degassing is done using any of the following degassing techniques or combinations thereof: heating, helium sparging, vacuum degassing, filtering, freeze-pump-thawing, and sonication.
  • degassing the fluid can include de-bubbling the fluid to remove any small gas bubbles that form or may be present in the fluid. De-bubbling is provided by filtering the fluid. In some embodiments, the fluid may not be degassed (e.g., removing gas dissolved at the molecular level), but may be passed through a de-bubblerto remove the small gas bubbles from the fluid.
  • the degassing system 41 can include a dissolved gas sensor to determine whether the treatment fluid is sufficiently degassed for a particular endodontic treatment.
  • a dissolved gas sensor is disposed downstream of the mixing system 43 and used to determine whether mixing of solutes has increased the dissolved gas content of the treatment fluid after addition of solutes, if any.
  • the solute source 42 may include a dissolved gas sensor
  • a dissolved gas sensor may measure the amount of dissolved oxygen in the fluid as a proxy for the total amount of dissolved gas in the fluid, since dissolved oxygen is measured more readily than dissolved gas (e.g., nitrogen or helium).
  • the degassed fluid is used, for example, to generate the high-velocity liquid beam for generating pressure waves, to substantially fill or irrigate a chamber in the tooth (e.g., the pulp cavity and/or canal spaces), to provide a propagation medium for acoustic waves, to inhibit formation of air (or gas) bubbles in the tooth chamber (e.g., in canal spaces or tubules), and/or to provide flow of the degassed fluid into small spaces in the tooth (e.g., small canals, tubules, etc.).
  • use of a degassed fluid may inhibit bubbles from forming in the jet due to the pressure drop at a nozzle orifice where the liquid jet is formed.
  • examples of methods for endodontic treatment comprise flowing a degassed fluid onto a tooth or tooth surface or into a tooth chamber.
  • the degassed fluid may comprise a tissue dissolving agent and/or a decalcifying agent.
  • the degassed fluid may have a dissolved oxygen content less than about 9 mg/L, less than about 7 mg/L, less than about 5 mg/L, less than about 3 mg/L, less than about 1 mg/L, or some other value.
  • a fluid for endodontic treatment may comprise a degassed fluid with a dissolved oxygen content less than about 9 mg/L, less than about 7 mg/L, less than about 5 mg/L, less than about 3 mg/L, less than about 1 mg/L, or some other value.
  • the fluid may comprise a tissue dissolving agent and/or a decalcifying agent.
  • the degassed fluid may comprise an aqueous solution of less than about 6% by volume of a tissue dissolving agent and/or less than about 20% by volume of a decalcifying agent.
  • FIGURE 6A is a block diagram that schematically illustrates an embodiment of a system 38 adapted to generate a high- velocity jet 60 of fluid for use in dental procedures.
  • the system 38 comprises a motor 40, a fluid source 44, a pump 46, a pressure sensor 48, a controller 51, a user interface 53, and a handpiece 50 that is operated by a dental practitioner to direct the jet 60 toward desired locations in a patient's mouth.
  • the pump 46 can pressurize fluid received from the fluid source 44.
  • the pump 46 may comprise a piston pump in which the piston is actuatable by the motor 40.
  • the high-pressure liquid from the pump 46 is fed to the pressure sensor 48 and then to the handpiece 50, for example, by a length of high-pressure tubing 49.
  • the fluid source 44 may comprise a fluid container (e.g., an intravenous bag) holding any of the treatment fluids described herein.
  • the treatment fluid is degassed, with a dissolved gas content less than normal (e.g., non-degassed) fluids.
  • treatment fluids include sterile water, a medical-grade saline solution, an antiseptic or antibiotic solution (e.g., sodium hypochlorite), a solution with chemicals or medications, or any combination thereof. More than one fluid source is used. In certain embodiments, it is advantageous for jet formation if the liquid provided by the fluid source 44 is substantially free of dissolved gases, which may reduce the effectiveness of the jet and the pressure wave generation.
  • the fluid source 44 comprises degassed liquid such as, e.g., degassed distilled water.
  • a bubble detector (not shown) is disposed between the fluid source 44 and the pump 46 to detect bubbles in the liquid and/or to determine whether liquid flow from the fluid source 44 has been interrupted or the container has emptied.
  • degassed fluids may be used.
  • the bubble detector is used to determine whether small air bubbles are present in the fluid that might negatively impact jet formation or acoustic wave propagation.
  • a filter or de-bubbler (not shown) is used to remove small air bubbles from the liquid.
  • the liquid in the fluid source 44 may be at room temperature or may be heated and/or cooled to a different temperature.
  • the controller 51 may comprise a microprocessor, a special or general purpose computer, a floating point gate array, and/or a programmable logic device.
  • the controller 51 may be used to control safety of the system 38, for example, by limiting system pressures to be below safety thresholds and/or by limiting the time that the jet 60 is permitted to flow from the handpiece 50.
  • the system 38 may also include a user interface 53 that outputs relevant system data or accepts user input (e.g., a target pressure).
  • the user interface 53 comprises a touch screen graphics display.
  • the user interface 53 may include controls for a dental practitioner to operate the liquid jet apparatus.
  • the controls can include a foot switch to actuate or deactuate the jet.
  • the system 38 may include additional and/or different components and may be configured differently than shown in FIGURE 6A .
  • the system 38 may include an aspiration pump that is coupled to the handpiece 50 (or an aspiration cannula) to permit aspiration of organic matter from the mouth or tooth 10.
  • the system 38 may comprise other pneumatic and/or hydraulic systems adapted to generate the high-velocity beam or jet 60.
  • the solute(s) can include antiseptic or antibacterial fluids or compounds (e.g., NaOCI or EDTA), surfactants, medicaments, nanoparticles, etc.
  • Liquid solute(s) may, but need not be, degassed.
  • the solvent and solutes flow to the fluid platform 61 via the tubing 49.
  • the fluid platform 61 can include any of the example fluid platforms or other components described herein.
  • the fluid platform 61 can include a pressure wave generator to generate acoustic waves in the tooth to provide tooth cleaning.
  • the fluid platform 61 can include a fluid outlet that can remove fluid from the tooth. At least a portion of this fluid is passed to a monitoring system 45, which can monitor the fluid flowing from the tooth to determine the extent or progress of the treatment.
  • the monitoring system 45 can include one or more monitoring sensors 74 that is generally similar to the monitoring sensors described with reference to FIGURE 3C .
  • the monitoring system 45 may monitor the extent or progress of tooth cleaning and may signal the dental practitioner, via the user interface 53, when the cleaning is complete.
  • the controller 51 or the monitoring system 45
  • may use feedback e.g., based on properties monitored by the monitoring system to regulate, adjust, or control components of the system during the treatment.
  • feedback advantageously may allow aspects of the endodontic treatment to be automated. For example, feedback is used to activate or deactivate a pressure wave generator or fluid source to more efficiently provide treatment to the patient.
  • a fluid outlet is connected to a suction system 47, which is similar to suction or evacuation units found in dental offices.
  • some dental evacuation units are designed to operate at about -6 in-Hg to about -8 in-Hg and have an airflow rate of about 12 cubic meters per hour (7 standard cubic feet per minute (SCFM)) per chairside high-volume inlet. Independent vacuum systems are used.
  • the operating pressure of the evacuation unit is about -4 to -10 in-Hg. In other embodiments, the operating pressure is in a range of about -0.1 to -5 in-Hg or -5 to -10 in-Hg or -10 to -20 in-Hg, or other values.
  • the flow provided by the evacuation unit is pulsating.
  • the evacuation unit flow is intermittent. In one embodiment, the evacuation unit flow is substantially uniform.
  • the air flow rate of the evacuation unit can be 8,5 to 15 or 3.4 to 22 or 0.17 to 12 or 12 to 25 or 25 to 51 cubic meters per hour (5 to 9 SCFM or 2 to 13 SCFM or 0.1 to 7 SCFM or 7 to 15 SCFM or 15 to 30 SCFM or 30 to 50 SCFM), or other values.
  • the solute mixing system 43 is downstream from the degassing system 41.
  • Some solutes are able to chemically degrade wet components of the degassing system 41 (e.g., bleach can attack gaskets, filters, etc.).
  • An advantage of the downstream arrangement shown in FIGURE 6B is that such solutes can be added after the solvent has been degassed; therefore, these solutes will not pass through (and possibly degrade) the degassing system 41.
  • heat dissipated by the pressure wave generator 64 may accumulate and may cause a temperature increase in the fluid in the tooth chamber 65 (and/or in the tooth). A sufficient temperature increase may be damaging to the oral tissues. A significant temperature increase may occur during some procedures utilizing certain embodiments of uncontrolled fluid platforms.
  • the mean fluid temperature and the mean tooth temperature may remain below temperatures safely tolerated by oral tissues.
  • the mean temperature remains between about 30 to 40 °C. In other embodiments, the mean temperature remains between about 20 to 50 °C, 10 to 60 °C, 5 to 70 °C, or else. The temperature may fluctuate and vary throughout the pulp cavity during the treatment and therefore the mean value of temperature may vary or fluctuate.
  • the temperature of the fluid inside the pulp cavity and the temperature of the tooth can depend at least in part on factors including the temperature of the treatment fluid supplied to the tooth, the heat dissipation rate of the pressure wave generator 64, the temperature of the fluid supply line (including the pump), and the flow rate of the treatment fluid. One or more of these factors (or others) are adjusted during treatment to maintain a desired temperature of the fluid in the tooth, the tooth itself, the fluid flowing from the pulp chamber, etc.
  • one or more temperature sensors e.g., thermistors
  • the systems shown in FIGURES 6A and 6B can include additional components (not shown) to regulate the temperature of the fluid anywhere along the fluid paths illustrated.
  • the system 38 may include additional and/or different components and may be configured differently than shown in FIGURE 6B .
  • the mixing system 43 and the degassing system 41 are combined. Either or both of these systems are disposed anywhere in the fluid flow path upstream of the fluid platform 61.
  • other embodiments do not need to include all the components shown in FIGURES 6 A and 6B .
  • some embodiments do not include a degassing system, a mixing system, and/or a monitoring system.
  • FIGURES 6A and 6B are intended to be illustrative of the type of fluid arrangements that are possible and are not intended to be limiting.
  • the system 38 is configured to produce a liquid jet 60 that forms a substantially parallel beam (e.g., is "collimated") over distances ranging from about 0.01 cm to about 10 cm.
  • the velocity profile transverse to the propagation axis of the jet is substantially constant (e.g., is "coherent”).
  • the jet velocity is substantially constant across the width of the jet. Therefore, in certain advantageous embodiments, the liquid jet 60 delivered by the dental handpiece 50 may comprise a coherent, collimated jet (a "CC jet").
  • the CC jet may have velocities in a range from about 100 m/s to about 300 m/s, for example, about 190 m/s in some embodiments.
  • the CC jet can have a diameter in a range from about 5 microns to about 1000 microns, in a range from about 10 microns to about 100 microns, in a range from about 100 microns to about 500 microns, or in a range from about 500 microns to about 1000 microns. Further details with respect to CC jets that can be produced by embodiments of the system and apparatus described herein can be found in U.S. Patent Publication No. 2007/0248932 and/or U.S. Patent Publication No. 2011/0117517 .
  • FIGURE 7 is a side view schematically illustrating an embodiment of a handpiece 50 comprising an embodiment of a positioning member configured to deliver the liquid jet 60 to a portion of the tooth 10.
  • the positioning member comprises a guide tube 100.
  • the handpiece 50 comprises an elongated tubular barrel 52 having a proximal end 56 that is adapted to engage tubing 49 from the system 38 and a distal end 58 adapted to be coupled or attached to the tooth 10.
  • the barrel 52 may include features or textures 55 that enhance grasping the handpiece 50 with the fingers and thumb of the operator.
  • the handpiece 50 is configured to be handheld. In some cases, the handpiece 50 is configured to be portable, movable, orientable, or maneuverable with respect to the patient. In some implementations, the handpiece 50 is configured to be coupled to a positioning device (e.g., a maneuverable or adjustable arm).
  • a positioning device e.g., a maneuverable or adjustable arm
  • the distal end 58 of the handpiece 50 can comprise a housing or cap 70 that is coupled to the tooth 10 (see, e.g., FIG. 4D ).
  • the cap 70 is a detachable member that is sized/shaped to fit on the patient's tooth and/or to position the distal end of the guide tube 100 at a desired location in the pulp cavity 26.
  • a kit of caps are provided such that a dental practitioner can select an appropriately-sized cap and attach it to the handpiece 50 (see, e.g., description of tooth sizing below).
  • the handpiece 50 may include a fluid inlet 71 for delivering treatment fluid to the tooth chamber 65, a fluid outlet 72 for removing fluid from the tooth (e.g., waste fluid), a pressure wave generator 64, a power line (e.g., to provide energy to a pressure wave generator), or a combination of some or all of the foregoing.
  • the handpiece 50 may include other components such as, e.g., an irrigation line to irrigate the tooth area, a light source to illuminate the tooth area, etc.
  • the pressure wave generator 64 e.g., a liquid jet
  • the handpiece 50 is used to apply the pressure wave generator 64 relative to the tooth 10.
  • the handpiece 50 is applied to the tooth 10 so as to create a substantially closed fluid circuit as the distal end 58 of the handpiece 50 engages the tooth 10, thereby enabling fluid to be delivered into and out of the tooth chamber 65 without substantial spillage or leakage into the patient's mouth.
  • the handpiece 50 may include a fluid retention member (e.g., sponge or vent) to reduce the likelihood of fluid leakage and/or to allow fluid to flow from the tooth chamber 65 (e.g., to inhibit over pressurization or under-pressurization).
  • the fluid retention member is configured to inhibit air from entering the tooth chamber 65 (which may reduce the effectiveness of cavitation) while permitting air to enter a fluid outlet 72 (e.g., suction line).
  • the handpiece 50 is shaped or sized differently than shown in FIGURE 7 .
  • the elongated tubular barrel 52 may not be used, and a dental practitioner may maneuver the cap 70 into a desired location in the patient's mouth. The patient may bite down on the cap 70 to hold the cap 70 in place during a treatment (see, e.g., FIG. 11 ).
  • the handpiece 50 can include a device that is clamped or attached to the tooth 10 (e.g., via a rubber dam clamp commonly used in endodontic procedures) such that the device doesn't require substantial user intervention during the procedure (see, e.g., FIGS. 10A and 10B ).
  • the handpiece 50 can be disposable (e.g., single-use) or reusable. In one embodiment, the handpiece 50 is disposable, but the pressure wave generator 64 is reusable. In another embodiment, the handpiece 50 is reusable, and certain components of the pressure wave generator 64 (e.g., a guide tube) are disposable. In some embodiments, the distal end 58 of the handpiece 50 can include additional components such as, for example, a sealer or gasket (which may be an elastomeric material or a closed-cell foam), spacers (e.g., to position the distal end of the guide tube 100 at a desired location in the tooth chamber), vents, etc.
  • a sealer or gasket which may be an elastomeric material or a closed-cell foam
  • spacers e.g., to position the distal end of the guide tube 100 at a desired location in the tooth chamber
  • vents etc.
  • the distal end 104 of the guide tube 100 is sized or shaped so that the distal end 104 is positioned in the pulp cavity 26 of the tooth 10, e.g., near the pulpal floor, near openings to the canal space 30, or inside the canal openings.
  • the size of the distal end 104 of the guide tube 100 is selected so that the distal end 104 fits through the access opening of the tooth 10.
  • the width of the guide tube 100 is approximately the width of a Gates-Glidden drill, for example, a size 4 Gates-Glidden drill.
  • the guide tube 100 is sized similarly to gauge 18, 19, 20, or 21 hypodermic tubes.
  • the width of the guide tube 100 may be in a range from about 0.1 mm to about 5 mm, in a range from about 0.5 mm to about 2.0 mm, or some other range.
  • the length of the guide tube 100 is selected so that the distal end 104 of the guide tube 100 is disposed at a desired location in the mouth.
  • the length of the guide tube 100 between a proximal end 102 and the distal end 104 may be in a range from about 1 mm to about 50 mm, from about 10 mm to about 25 mm, or in some other range.
  • the length is about 13 mm or about 18 mm, which may allow the distal end 104 of the guide tube 100 to reach the vicinity of the pulpal floor in a wide range of teeth.
  • the distal end 104 of the guide tube 100 is inserted into the canal space of the tooth 10.
  • the guide tube 100 is attached to the handpiece 50, or, in some cases, be a detachable or removable member.
  • the guide tube 100 may be single-use or disposable.
  • a kit of guide tubes is provided, and a dental practitioner can select a guide tube having a desired length (see, e.g., description of tooth sizing below).
  • Certain embodiments of the guide tube 100 can comprise an impingement member 110 (which also may be referred to herein as a deflector).
  • the jet 60 can propagate along the channel 84 and impinge upon a surface of the impingement member 110, whereby at least a portion of the jet 60 is slowed, disrupted or deflected, which can produce a spray 90 of liquid.
  • the spray 90 may comprise droplets, beads, mist, jets, or beams of liquid in various implementations.
  • Embodiments of the guide tube 100 which include an impingement member 110 may reduce or prevent possible damage that may be caused by the jet 60 during certain dental treatments.
  • impingement member 110 may reduce the likelihood that the jet 60 may undesirably cut tissue or propagate into the root canal spaces 30 (which may undesirably pressurize the canal spaces in some cases).
  • the design of the impingement member 110 may also enable a degree of control over the fluid circulation or dynamic pressures that can occur in the pulp cavity 26 during treatment.
  • the guide tube 100 can include an opening 120 that permits the spray 90 to leave the distal end 104 of the guide tube 100.
  • multiple openings 120 are used, for example, two, three, four, five, six, or more openings.
  • the opening 120 can have a proximal end 106 and a distal end 108.
  • the distal end 108 of the opening 120 is disposed near the distal end 104 of the guide tube 100.
  • the opening 120 can expose the liquid jet 60 (and/or the spray 90) to the surrounding environment, which may include air, liquid, organic material, etc.
  • the opening 120 permits the material or fluid inside the pulp cavity 26 to interact with the jet 60 or spray 90.
  • a hydroacoustic field (e.g., pressure waves, acoustic energy, etc.) may be established in the tooth 10 (e.g., in the pulp cavity 26, the canal spaces 30, etc.) by the impingement of the jet 60 on the impingement member 110, interaction of the fluid or material in the tooth 10 with the jet 60 or they spray 90, fluid circulation or agitation generated in the pulp cavity 26, or by a combination of these factors (or other factors).
  • the hydroacoustic field may include acoustic power over a relatively broad range of acoustic frequencies (e.g., from about a few kHz to several hundred kHz or higher; see, e.g., FIG. 2B-1 ).
  • the hydroacoustic field in the tooth may influence, cause, or increase the strength of effects including, e.g., acoustic cavitation (e.g., cavitation bubble formation and collapse, microjet formation), fluid agitation, fluid circulation, sonoporation, sonochemistry, and so forth. It is believed, although not required, that the hydroacoustic field, some or all of the foregoing effects, or a combination thereof may act to disrupt or detach organic or inorganic material in the tooth, which may effectively clean the pulp cavity 26 and/or the canal spaces 30.
  • the length of the opening 120 between the proximal end 106 and the distal end 108 is referred to as X (see, e.g., FIG. 8 ).
  • the length X may be in a range from about 0.1 mm to approximately the overall length of the guide tube 100.
  • the length X is in a range from about 1 mm to about 10 mm.
  • the length X is selected so that the opening 120 remains submersed by fluid or material in the pulp cavity 26 of the tooth 10 during treatment.
  • a length X of about 3 mm is used for a wide variety of teeth.
  • the length X is a fraction of the overall length of the guide tube 100.
  • the fraction can be about 0.1, about 0.25, about 0.5, about 0.75, about 0.9, or a different value.
  • the length X is a multiple of the width of the guide tube 100 or the channel 84.
  • the multiple can be about 0.5, about 1.0, about 2.0, about 4.0, about 8.0, or a different value.
  • the multiple can be in a range from about 0.5 to about 2.0, about 2.0 to about 4.0, about 4.0 to about 8.0, or more.
  • the length X is a multiple of the width of the jet, e.g., 5 times, 10 times, 50 times, or 100 times the width of the jet.
  • the multiple can be in a range from about 5 to about 50, about 50 to about 200, about 200 to about 1000, or more.
  • the length X of the opening 120 is selected (at least in part) such that the hydroacoustic field generated in a tooth has desired properties including, e.g., desired acoustic power in the tooth at one or more acoustic frequencies.
  • the length of X is selected so that both the proximal and distal ends 106, 108 of the opening 120 remain submerged in fluid during treatment.
  • the guide tube 100 is used to deliver a pressure wave generator 64 to the tooth chamber 65.
  • Embodiments of the guide tube 100 may, but need not, be used with non-jet pressure wave generators.
  • an optical fiber is disposed along the lumen or channel 84 of the guide tube 100.
  • the fiber can have a tip configured to radiate light energy propagating in the fiber out into the fluid in the tooth chamber 65.
  • the tip may be disposed so that the radiating light energy can exit the tip through a window 120 in the guide tube 100.
  • the tip of the fiber may extend beyond the distal end 104 of the guide tube 100 (e.g., the impingement member 110 (described below) and the window 120 need not be used).
  • flow restrictors are used to help retain fluid in the tooth chamber 65, to inhibit backflow or splashing of fluid from the tooth, to permit fluid to leave the tooth chamber 65 to (e.g., to reduce the potential for over-pressurization of the chamber), to inhibit air from entering the tooth chamber 65 (which may reduce the effectiveness of pressure waves), and/or to permit air to be entrained with fluid removed from the tooth chamber 65 (e.g., to reduce the potential for under-pressurization of the chamber).
  • flow restrictors 68 can include sponges, vents, permeable or semi-permeable membranes, etc. that will be described with reference to FIGURES 12A and 12B .
  • the sponge is removably attached to the guide tube 100 in some cases.
  • the sponge is configured to conform to the crown 12 of the tooth 10 under treatment.
  • the sponge is configured such that jet or spray that emerges from the opening 120 (or liquid from other sources such as, e.g., the flow tube) is sufficiently retained within the pulp cavity 26 so that the distal end 104 of the guide tube 100 may be contained or submersed in the fluid.
  • the sponge is attached to the distal end 58 of the handpiece 50 via an adhesive, clip, etc.
  • the sponge may instead be attached directly to the tooth (or to the tooth seal 75, if used).
  • the flow restrictor 68 may, but does not need to, substantially seal the opening to a cavity in the tooth 10 such that the cavity is substantially water tight.
  • the flow restrictor 68 inhibits back flow (e.g., splashback) of fluid out of the cavity but need not prevent all fluid outflow from the tooth 10.
  • one or more openings are formed in the tooth (e.g., via drilling) to allow some fluid to flow out of the cavity in the tooth 10, and the restrictor is used to reduce or prevent fluid backflow out of other opening(s) (e.g., a coronal access opening).
  • the flow restrictor 68 may include a sponge.
  • the sponge is formed from a material that is not adversely affected by chemicals or irrigation solutions such as, e.g., sodium hypochlorite, used during root canal procedures.
  • the sponge may comprise any suitable porous and/or absorbent material (or materials).
  • the sponge may comprise a porous material (e.g., elastomeric, plastic, rubber, cellulose, fabric, foam, etc.) that can at least partially absorb liquid.
  • the porous material may comprise an open-cell foam or a closed-cell foam.
  • the foam can comprise polyvinyl foam, polyethylene foam, polyvinyl alcohol (PVA) foam, urethane foam, cellulose foam, silicone foam, etc.
  • the flow restrictor 68 may comprise a permeable or semi-permeable membrane.
  • the flow restrictor 68 material is deformable and may be capable of deforming to contours of tooth surfaces.
  • the sponge comprises a material having a density in a range from about 1 to about 1000 kg/m 3 , or in a range of about 10 to about 400 kg/m 3.
  • the sponge comprises a closed-cell vinyl foam having a density of about 160 kg/m 3 or about 176 kg/m 3.
  • a silicone foam is used.
  • the sponge can have a tensile strength in a range from about 1 kPa to about 3000 kPa or in a range of about 50 kPa to about 400 kPa.
  • the sponge can have an ultimate elongation in a range of about 5% to about 800% or in a range of about 50% to about 300%.
  • the sponge comprises cells and can have a visual cell count in a range of about 1 to about 250/cm or in a range from about 10 to about 40/cm.
  • the foam may comprise an ester or another type of foam.
  • the flow restrictor 68 can comprise one or more vents, e.g., openings, pores, channels, lumens, etc. that may permit some passage of air or liquid.
  • FIGURE 12A schematically depicts two example handpieces having different arrangements of vents 73 toward the distal end 58 of the handpiece 50.
  • the vents 73 can have any size, shape, and/or configuration.
  • the vents 73 are circular, oval, elliptical, rectangular, polygonal, etc. Any number of vents can be used including, zero, one, two, three, four, five, or more vents.
  • the vents 73 are disposed on the distal end 58 of the handpiece 50, on the cap 70, or elsewhere on the handpiece 50. In various embodiments, the vents are disposed along (and be in fluid communication with) a fluid outlet and/or a fluid inlet.
  • FIGURE 12B is a top cross-section view of an embodiment of a handpiece 50 that schematically illustrates an example configuration of vents 73, which inhibits or prevents air from entering the pulp chamber 28 of the tooth 10.
  • a pressure wave generator 64 or a fluid inflow line
  • the fluid outflow surrounds the pressure wave generator (or fluid inflow line).
  • Two vents 73 are shown that are angled away from the pressure wave generator 64 (or fluid inflow line) and angled toward the direction of fluid flow in the fluid outlet 72 (see, e.g., arrow 94a).
  • the vents 73 comprise channels or lumens with a first end 73a on the outer surface of the handpiece 50, and a second end 73b joining the fluid outlet 72.
  • Ambient air can flow from the first end 73a to the second end 73b and join or be entrained in flow in the fluid outlet 72.
  • fluid in the tooth chamber can flow out the vents 73 (e.g., the fluid can enter the second end 73b of the vent and leave the handpiece at the first end 73a of the vent).
  • the fluid outlet 72 may have an outlet axis generally along the fluid outflow direction (e.g., the arrow 94a), and a vent may have a vent axis generally along the airflow direction (e.g., the arrow 92b).
  • an angle between the vent axis and the outlet axis is less than about 90 degrees, less than about 60 degrees, less than about 45 degrees, less than about 30 degrees, less than about 15 degrees, or some other angle.
  • An advantage of some embodiments in which the angle is an acute angle is that the ambient airflow 92b can relatively smoothly join (or be entrained in) the fluid flow in the outlet 72. Further, some such embodiments may inhibit ambient air from flowing against the flow in the outlet 72 and entering the tooth chamber 65, where such ambient air may tend to inhibit cavitation effects in some treatments.
  • the vents 73 can extend from the outside of the handpiece 50 (where they can communicate with ambient air) to the fluid outlet line 72.
  • the ambient air can flow towards an evacuation or suction unit that may also be used for removing waste fluid.
  • the outflow line therefore can include both fluid 92b (e.g., waste fluid from the tooth) and ambient air 94b from the vents 73.
  • the vents are positioned with respect to an evacuation line in such a way that air entrained into the handpiece 50 does not flow over the access opening of the tooth, where the waste fluid comes out.
  • the vents 73 are designed to improve the safety of the fluid platform so that operating fluid pressures within the tooth chamber 65 remain at desired or safe levels. Use of the vents 73 can allow for a fluid platform which is open but in which the pressure and fluid flow is at least partially controlled. Although some closed fluid platforms are relatively straightforward, in practice, they may require that the fluid inflow and outflow be highly controlled or precisely matched, or that the system be equipped with safety valves and/or shutoff switches. In some cases, such additions to the system not only can complicate the design of the system but may raise the number of possible failure points within the system.
  • vents 73 may allow the fluid platform to operate in a controlled and safe way. Additionally, the simplicity of the design of certain vents 73 can reduce the number of potential failure points. Further, some or all of the possible failure points are reduced to failure points which cause little or no hazard to the patient or practitioner.
  • vents 73 can provide for a self-regulating fluid platform, which depending on the state of the system, may allow air to be drawn into the fluid outflow path or may allow treatment fluid to overflow from the treatment area.
  • the size and position of the vents 73 is configured such that the system maintains a safe apical pressure during the following scenarios: while there is little or no flow or pressure through the inlet 71 or outlet 72, while there is an excess of flow or pressure through the inlet 71 or outlet 72, while there is a deficiency of flow or pressure through the inlet 71 or outlet 72, or combinations of the above scenarios.
  • vents 73 are placed along the fluid outlet path, away from the fluid inlet path, such that little or no air is drawn into the tooth chamber 65.
  • the vents 73 are designed such that air entering a fluid outflow line flows towards an evacuation unit; thereby inhibiting air from flowing toward the pulp chamber 28of tooth, as air in the pulp chamber 28may reduce the efficacy of treatment in some cases.
  • the vents 73 are placed relatively close to the distal end 58 of the handpiece 50.
  • the vents 73 should not be placed too far away from the tooth such that during treatment, or in case of any failures, the treatment fluid does not build up too much static pressure (positive or negative) inside the tooth and cause adverse effects (e.g. due to elevation difference or flow resistance in the outflow line).
  • the fluid outlet 72 may have a distal end in the fluid retainer 66.
  • the vents 73 are placed about 0 to about 5 mm from the end of the fluid outlet 72, about 0 to about 25 mm from the end of the fluid outlet 72, or about 0 to about 100 mm from the end of the fluid outlet 72, or any other value.
  • the aforelisted distances are measured with respect to an occlusal surface of the tooth or the endodontic access opening of the tooth.
  • the vents 73 are placed along the fluid inflow path (e.g., the fluid inlet side of the fluid retainer) and not along the fluid flow path.
  • a vent disposed along the fluid inflow path may open to shunt fluid out of the inflow path before such fluid would be delivered to the tooth chamber, which can at least partially alleviate the pressure rise.
  • Some embodiments can utilize vents on both the fluid inflow and the fluid outflow paths (e.g., vents disposed along the fluid inlet and along the fluid outlet).
  • the shape of the vents 73 can have a relatively large aspect ratio (e.g., the vent may have an elongated shape as opposed to a circle of the equivalent area).
  • a vent 73 with a relatively large aspect ratio may enable the vent 73 to avoid spilling fluid during normal operation (e.g., due to liquid surface tension) while providing air flow along the suction line.
  • the height of the vents are between about 0 to 1 mm, about 0 to 3 mm, about 0 to 10 mm, or about 0 to 20 mm.
  • the width of the vents are between about 0 to 2 mm, about 0 to 6 mm, or about 0 to 20 mm.
  • the aspect ratio (e.g., ratio of width to height) of the vent is about 1 :1, 1.25:1, 1.5: 1, 2: 1, 2.5: 1, 3: 1, or higher.
  • the aspect ratio is larger than about 1.5:1, larger than about 2: 1, larger than about 2.5:1, or larger than about 3: 1.
  • Some vents are circular or nearly circular (e.g., aspect ratio of about 1: 1).
  • some vents that are closer to the distal end 58 of the handpiece 50 e.g., closer to the tooth during treatment
  • the area of each vent can be in a range from about 0.5 mm 2 to 4 mm 2 , about 0.1 mm 2 to 3 mm 2 , about 0.01 mm 2 to 10 mm 2, or larger (e.g., up to about 100 mm 2).
  • vents 73 are used, for example, from 2 to 10, 2 to 50, or higher. It may be advantageous to have more than one vent spaced away from at least one other vent for the following some or all of the following reasons: to inhibit accidental blockage of a vent 73, to relieve pressure exerted via an additional suction system applied to a vent 73 (e.g., a handheld dental suction tube operated by a dental practitioner or assistant), to maintain the size of each vent 73 small enough to reduce waste fluid from spilling out of a vent 73 during normal operation (e.g., using surface tension), and/or to provide the air flow along the fluid outlet 72.
  • an additional suction system applied to a vent 73 e.g., a handheld dental suction tube operated by a dental practitioner or assistant
  • to maintain the size of each vent 73 small enough to reduce waste fluid from spilling out of a vent 73 during normal operation e.g., using surface tension
  • Multiple vents 73 can also be used to accommodate different positioning scenarios for the handpiece or fluid platform, e.g., left side of jaw, right side of jaw, upper teeth, or lower teeth). Multiple vents 73 can also help ensure that the fluid platform functions as desired when there are internal or external obstructions to fewer than all of the vents 73.
  • the vents 73 are properly sized, shaped, and arranged to allow for some or all of the following scenarios (or other scenarios).
  • the system is configured so that little or no pressure is exerted on the pulp chamber.
  • the vents 73 may include one or more one-way or check valves configured with a cracking pressure(s) to allow fluid from the tooth chamber 65 to leave (e.g., if the fluid pressure in the tooth chamber 65 exceeds the cracking pressure) while preventing ambient air from entering the tooth chamber 65 (unless the pressure in the tooth chamber 65 becomes too low).
  • vents 73 may depend on several parameters including, e.g., the operating pressure and flow rate of the evacuation units used with the system, the treatment fluid flow rate, the diameter of the fluid outflow line, etc.
  • the number, size, location, shape, and/or configuration of the vents 73 may vary in different embodiments. More than one possible design of vents 73 may function adequately for a certain set of operating parameters, and the design may be selected to achieve or optimize one or more of the foregoing design considerations (or other design objectives).
  • FIGURE 9 schematically illustrates an embodiment of a handpiece 50 that includes a fluid inlet 71 to deliver fluid to the guide tube 100, which is disposed in the tooth chamber 65.
  • the fluid can emerge as a high- velocity jet beam 60, interact with ambient fluid in the tooth chamber, strike an impingement surface 110 at the distal end of the guide tube 100, and disperse as a spray 90 to generate pressure waves 67.
  • the handpiece 50 also includes a fluid outlet 72 for removing fluid from the tooth 10.
  • the fluid outlet 72 is fluidly coupled to a suction line or evacuation system commonly found in dental offices.
  • FIGURE 11 schematically illustrates an alternative example of a fluid platform 61 that is applied to a tooth 10.
  • the fluid retainer 66 is placed on the tooth seal 75 (if used) of the tooth under treatment and is held in place by the patient biting down on the fluid platform 61 with the opposing tooth.
  • a rubber dam clamp 130 may additionally be used (see, e.g., FIGS. 10A and 10B ).
  • the fluid retainer includes a pressure wave generator 64 (e.g., a liquid jet), and a fluid outlet 72 comprising vents 73.
  • Pressure wave generators can include liquid jet devices, not claimed.
  • Mechanical energy pressure wave generators can also include rotating objects, e.g. miniature propellers, an eccentrically-confined rotating cylinder, a perforated rotating disk, etc.
  • These types of pressure wave generators can also include vibrating, oscillating, or pulsating objects such as sonication devices that create pressure waves via piezoelectricity, magnetostriction, etc.
  • electric energy transferred to a piezoelectric transducer can pressure waves in the treatment fluid.
  • the piezoelectric transducer is used to create acoustic waves having ultrasonic frequencies.
  • An electromagnetic beam of radiation (e.g., a laser beam) can propagate energy into the tooth chamber, and the electromagnetic beam energy is transformed into pressure waves as it enters the treatment fluid.
  • the electromagnetic energy is absorbed by the fluid (e.g., water) in the tooth chamber, which can generate localized heating and pressure waves that propagate in the fluid.
  • the pressure waves generated by the electromagnetic beam can generate photo-induced or photo-acoustic cavitation effects in the fluid.
  • the electromagnetic radiation from a radiation source is propagated to the tooth chamber by an optical waveguide (e.g., an optical fiber), and dispersed into the fluid at a distal end of the waveguide (e.g., a shaped tip of the fiber, e.g., a conically-shaped tip).
  • a radiation source e.g., a laser
  • an optical waveguide e.g., an optical fiber
  • dispersed into the fluid at a distal end of the waveguide e.g., a shaped tip of the fiber, e.g., a conically-shaped tip.
  • the radiation is directed to the tooth chamber by a beam scanning system.
  • the laser can include one or more of a diode laser, a solid state laser, a fiber laser, an Er:YAG laser, an Er:YSGG laser, an Er,Cr:YAG laser, an Er,Cr:YSGG laser, a Ho:YAG laser, a Nd:YAG laser, a CTE:YAG laser, a C0 2 laser, or a TkSapphire laser.
  • the source of electromagnetic radiation can include one or more light emitting diodes (LEDs). The electromagnetic radiation is used to excite nanoparticles (e.g., light-absorbing gold nanorods or nanoshells) inside the treatment fluid, which may increase the efficiency of photo-induced cavitation in the fluid.
  • the treatment fluid can include excitable functional groups (e.g., hydroxyl functional groups) that are susceptible to excitation by the electromagnetic radiation and which may increase the efficiency of pressure wave generation (e.g., due to increased absorption of radiation).
  • excitable functional groups e.g., hydroxyl functional groups
  • radiation having a first wavelength is used (e.g., a wavelength strongly absorbed by water) followed by radiation having a second wavelength not equal to the first wavelength (e.g., a wavelength less strongly absorbed by water).
  • the first wavelength may help create bubbles in the tooth fluid
  • the second wavelength may help disrupt the tissue.
  • electromagnetic energy is added to other pressure wave generation modalities.
  • electromagnetic energy is delivered to a tooth chamber in which a mechanical energy pressure wave generator (e.g., a liquid jet) is used to generate the acoustic waves.
  • a mechanical energy pressure wave generator e.g., a liquid jet
  • Acoustic energy is generated from electric energy transferred to an ultrasound transducer or an ultrasonic tip (or file or needle) that creates pressure waves in the treatment fluid.
  • the ultrasonic transducer may comprise a piezoelectric crystal that physically oscillates in response to an electrical signal or a magnetostrictive element that converts electromagnetic energy into mechanical energy.
  • the transducer is disposed in the treatment fluid, for example, in the fluid inside the pulp cavity or in the fluid contained within the fluid platform (but outside the pulp cavity).
  • An example of the power spectrum that is produced by an ultrasonic device is shown in FIGURE 2B-2 .
  • Ultrasonic sources can provide acoustic power in a frequency range from about 20 kHz to about 40 kHz (e.g., about 30 kHz) in various embodiments. Sonic (e.g., frequencies less than about 20 kHz such as about 1 kHz to 8 kHz) or megasonic energy (e.g., frequencies greater than about 1 MHz) is used in some embodiments.
  • Sonic e.g., frequencies less than about 20 kHz such as about 1 kHz to 8 kHz
  • megasonic energy e.g., frequencies greater than about 1 MHz
  • a pressure wave generator 64 is placed at a desired location with respect to the tooth.
  • the pressure wave generator 64 creates pressure waves 67 within the fluid inside the tooth (the generation of pressure waves 67 may or may not create or cause cavitation).
  • the pressure waves 67 propagate throughout the fluid inside the tooth, with the fluid in the tooth serving as a propagation medium for the pressure waves 67.
  • the pressure waves 67 can also propagate through tooth material (e.g., dentin). It is believed, although not required, that as a result of application of a sufficiently high-intensity pressure wave, acoustic cavitation may occur.
  • the collapse of cavitation bubbles may induce, cause, or be involved in a number of processes described herein such as, e.g., sonochemistry, tissue dissociation, tissue delamination, sonoporation, and/or removal of calcified structures.
  • a smear layer in a canal space includes a layer of dentin, organic and inorganic debris, and bacteria created during instrumentation of canals (e.g., by endodontic files).
  • the cavitation effects discussed herein can be effective at removing the smear layer.
  • the pressure wave generator 64 is configured such that the pressure waves 67 (and/or cavitation) do not substantially break down natural dentin in the tooth.
  • the pressure wave field by itself or in addition to cavitation may be involved in one or more of the abovementioned processes.
  • the pressure wave generator 64 is disposed in suitable locations.
  • the pressure wave generator 64 is attached to a handpiece 50 that can be maneuvered in a patient's mouth.
  • the distal end of the pressure wave generator 64 is disposed inside the pulp cavity 26, for example, in close proximity to the canals on the pulp chamber 28 floor.
  • the pressure waves 67 may have an increased effect on cleaning, decalcifying, and removing a smear layer within the canals and the pulpal chamber the closer the pressure wave generator 64 is to the canals.
  • the distal end of the pressure wave generator 64 is located at a distance of about 1 mm to about 3 mm from the pulp chamber floor.
  • the desired distance may depend on the modality used to create the pressure waves 67 in the fluid (e.g., mechanical, electromagnetic, acoustic).
  • the distal end of the pressure wave generator 64 is located inside a root canal 30.
  • the guide tube 100 can comprise a flexible material that is directed down a canal toward the apex of the canal.
  • the distal end of the pressure wave generator 64 is positioned outside the pulp cavity 26 but exposed to fluid in the pulpal cavity.
  • the distal end of the pressure wave generator 64 is positioned inside the root canal space 30.
  • the pressure wave generator 64 (or fluid inlet 71) causes a stream of fluid to flow into the root canal, dynamic pressurization of the root canal may occur, which in turn may cause periapical extrusion of materials in some patients.
  • the parameters influencing dynamic pressurization can include, e.g., the direction, shape, and speed of the stream of fluid with respect to the canal orifices and also the pulp cavity shape and topology.
  • the pressure wave generator 64 if the pressure wave generator 64 enters the root canal orifice and substantially blocks the root canal pathway, the blockage may decelerate or even stop the set of physicochemical phenomena used to clean and disinfect the root canals.
  • the pressure wave generator 64 is designed such that the distal end of the pressure wave generator 64 is located at a desired or prescribed location in the pulp chamber 28of the teeth.
  • the energy source that provides the energy for the pressure wave generator 64 is located outside the handpiece, inside the handpiece, integrated with the handpiece, etc.
  • FIGURE 13A schematically illustrates an access opening 25 formed in a tooth 10.
  • a drill or grinding tool can initially be used to make the opening 25 in the tooth 10.
  • the opening 25 may extend through the enamel 22 and the dentin 20 to expose and provide access to pulp in the pulp cavity 26.
  • the opening 25 is made in a top portion of the crown 12 of the tooth 10 or in another portion such as a side of the crown 12, near the cemento-enamel junction 15, or in the root 16 below the gum 14.
  • the opening 25 is sized and shaped as needed to provide suitable access to the diseased pulp and/or some or all of the canal spaces 30.
  • a fluid platform 61 or handpiece 50 is applied or attached to the tooth so as to enable an endodontic procedure in the tooth.
  • an (optional) tooth seal 75 is formed on the tooth to provide a flat surface 76 to which a fluid platform 61 or handpiece 50 is applied.
  • FIGURE 13B schematically illustrates an embodiment of the tooth seal 75 applied to a perimeter of a crown 12 of the tooth 10 of FIGURE 13A .
  • the upper surface 76 of the tooth seal 75 is made substantially flat after application and removal of a flat plate.
  • the tooth seal 75 is used to temporarily fill grooves, dents, or imperfections of the occlusal surface of the tooth or to create a substantially flat surface 76 that a cap 70 of a fluid platform 61 or handpiece 50 can engage with.
  • a tooth seal 75 can facilitate a water-tight and/or air-tight seal that substantially inhibits entry into and/or escape of liquid or air from the pulp chamber 28.
  • the tooth seal 75 is used to form a substantially hermetic seal of the pulp chamber 28.
  • the tooth seal 75 can help the cap 70 engage with a tooth with substantial crown irregularities or irregularities due to other reasons, thereby sealing irregularities that the cap 70 would not be able to easily fill in by itself.
  • FIGURE 13C schematically illustrates an embodiment of a tooth seal 75 applied to a tooth 10 in which a portion 77 of the crown 12 is missing due to decay or damage.
  • the tooth seal 75 has been used to cover or build up the portion 77 of the crown 12 so that the tooth seal 75 (and the non-decayed portion of the tooth) form a substantially complete chamber for subsequent fluid treatments.
  • An example method for applying the tooth seal 75 to a tooth is as follows.
  • An endodontic access opening 25 in the tooth is made, e.g., using standard endodontic access preparation techniques, substantially as used in conventional root canal procedures.
  • the canals are prepared using standard techniques.
  • the canals are not prepared.
  • Tooth seal material is applied on the occlusal surface of the tooth and/or also around perimeter of the crown 12. Decayed or diseased portions of the tooth are built up using the tooth seal material or other composite material.
  • a flat plate is applied to the tooth seal material, e.g., by pushing the plate onto the material, thereby creating a substantially flat surface beneath the plate.
  • the operator can wait until the material sets or can use a curing light to cure the material (if photo-curable).
  • the flat plate is removed from the tooth seal material. If any of the material has penetrated the pulp chamber 28 or blocked the endodontic access opening 25, the material is removed with a tool (e.g. dental bur).
  • a fluid platform 61, handpiece 50, or cap 70 is applied to the flat surface of the tooth material and the endodontic procedure can begin.
  • the tooth seal 75 is applied to the tooth before the endodontic access opening 25 is formed.
  • the endodontic access opening 25 can then be formed for both dentin and the tooth seal material. In this case, using a substantially transparent material may be preferred to improve visibility for endodontic access.
  • the tooth seal material may adhere to the tooth by itself or may be attached to the tooth using adhesive.
  • the tooth seal material is applied in such a way so that it flows over and into a rubber dam clamp, which upon setting/curing enforces the attachment of the tooth seal material onto the tooth.
  • the material at least partially adheres to the tooth while engaging with the rubber dam clamp.
  • the distal end of a fluid inlet 71 and/or a pressure generator 64 is positioned inside the pulp chamber 28 with the distal end at a desired distance from a root canal orifice.
  • a fluid inlet 71 and/or a pressure generator 64 is positioned inside the pulp chamber 28 with the distal end at a desired distance from a root canal orifice.
  • FIGURE 14A schematically illustrates an example of a sizer 132 inserted into a pulp chamber 28 of an example tooth 10.
  • the sizer 132 is too large for the pulp chamber 28.
  • FIGURE 14B schematically illustrates another example of a sizer 132 inserted into the pulp chamber 28 of a tooth 10.
  • the sizer 132 is the desired size for the pulp chamber 28. The sizer 132 is moved laterally across the width of the chamber, with the solid lines showing the sizer 132 in a first position and the dashed lines showing the sizer 132 in a different position in the pulp chamber 28.
  • FIGURE 14B shows a sizer 132 with an appropriate pin length for the illustrated tooth 10, because the distal end 142 of the pin 140 is positioned an appropriate height above the pulp floor (as indicated by the horizontal dashed line 144). This sizer 132 is used to establish the depth of the pulp chamber 28.
  • the fluid retainer 66 may include a cap 70 (and an optional sealer 68) that is sized so that a distal end of a fluid inlet 71 or pressure wave generator 64 is at a desired location in the tooth chamber 65.
  • each sizer 132 is associated with a cap 70 that is applied to the tooth.
  • the cap 70 can, in some cases, be attached to the distal end 58 of the handpiece 50 or manually applied to the tooth 10 (without using the handle of a handpiece).
  • the cap 70 is used so that the distal end of the fluid inlet 71 or pressure wave generator 64 is located at the desired height above the pulp floor (indicated by the horizontal dashed line 144 in FIG. 15C ) when the handpiece 50 is applied to the tooth seal 75.
  • the cap 70 can include a sealer 68, which is a flexible gasket (e.g., a sponge) that helps maintain water-tight or air-tight coupling between the cap 70 and the tooth seal 75, so that fluid does not leak out of the tooth 10 during treatment.
  • a flexible sealer 68 is able to accommodate movement of the handpiece 50 on the tooth as the dental practitioner maneuvers the handpiece into position.
  • the sealer 68 is disposed at the distal end of the cap 70 (see, e.g., FIG. 3 A) or is disposed inside the cap 70 (see, e.g., FIG. 3B ).
  • the sealer functions as the flow restrictor 68 and inhibits backflow or splashing from the tooth chamber 65, helps retain fluid in the tooth chamber 65, and can permit air to flow into a suction line.
  • the tooth chamber 65 is cleaned.
  • a fluid retainer 66 is applied to the tooth and used to circulate a cleaning solution (e.g., antiseptic or antibiotic) in the tooth chamber 65 (see, e.g., FIG. 3A ).
  • a pressure wave generator 64 is activated to generate acoustic waves 67 that propagate through the tooth 10 (see, e.g., FIG. 2A ).
  • the acoustic waves 67 can generate acoustic cavitation, which may effectively clean the root canals of the tooth 10.
  • the fluid flowing from the tooth 10 is monitored to determine when the cleaning is complete (see, e.g., FIG. 3C ).
  • FIGURE 17 is a flowchart illustrating an example method of using a degassed fluid during an endodontic procedure.
  • a degassed fluid is introduced into a tooth chamber 65.
  • the degassed fluid is delivered from a source of degassed fluid such as, e.g., a reservoir (e.g., bottle) or is delivered as the output from a degassing unit.
  • the degassed fluid is introduced into the tooth chamber using a fluid inlet or fluid introducer in various embodiments.
  • the degassed fluid may circulate in the tooth chamber.
  • acoustic waves is generated in the degassed fluid in the tooth.
  • the acoustic waves may, but need not, generate acoustic cavitation in fluid in the tooth.
  • the acoustic waves may propagate through the degassed fluid to surrounding dentin structure of the tooth.
  • Block 250 is optional in some procedures, as the flowing degassed fluid is used to irrigate tooth tissue.
  • the degassed fluid may include solutes (e.g., an antiseptic, antibiotic, or decalcifying agent) that may clean the tooth chamber.
  • the degassed fluid may inhibit the formation of gas bubbles in the tooth chamber, and may allow the degassed fluid to flow into small tooth spaces (e.g., tubules, small canals) to provide more effective cleaning.
  • a chemical reaction front may generally refer to an interface between the tissue and the solution which contains a chemical such as a tissue dissolving agent.
  • Tissue may refer to all types of cells existing in the tooth as well as bacteria and viruses.
  • Calcified tissue may refer to calcified pulp, pulp stones, and tertiary dentin.
  • Bubbles includes but is not limited to bubbles created due to a chemical reaction, dissolved gas remaining in the fluid after degassing (if used) and released as bubbles in the fluid, and any bubbles which are introduced into the tooth due to imperfect sealing.
  • Tissue cleaning treatments may utilize one or more of the physicochemical effects described herein to clean and remove tissue and/or calcified tissue from a tooth chamber.
  • the combination of (1) pressure waves (e.g., generation of acoustic cavitation), (2) circulation of fluid in the tooth chamber (e.g., macroscopic eddies and flows), and (3) chemistry (e.g., use of a tissue dissolving agent, use of degassed fluids) can provide highly effective cleaning.
  • certain embodiments of the systems disclosed herein utilize a pressure wave generator to generate the acoustic waves, a fluid platform (e.g., fluid retainer) to retain treatment fluid in the tooth chamber and to enable circulation of the treatment fluid, and a treatment fluid that is degassed or includes a chemical agents such as a tissue dissolving agent.
  • a pressure wave generator to generate the acoustic waves
  • a fluid platform e.g., fluid retainer
  • a treatment fluid that is degassed or includes a chemical agents such as a tissue dissolving agent.
  • a pressure wave generator is used to generate pressure waves that propagate through the fluid in the tooth chamber (and the tooth).
  • a fluid with high intensity pressure waves e.g., sonic or ultrasonic frequencies
  • acoustic cavitation may occur.
  • the implosive collapse of the cavitation bubbles can produce intense local heating and high pressures with short lifetimes. Therefore, in some treatment methods, acoustic cavitation is responsible for or involved in enhancing chemical reactions, sonochemistry, sonoporation, tissue dissociation, tissue delamination, as well as removing the bacteria and/or the smear layer from the root canals and tubules.
  • the effects of enhancing chemical reaction via vibrations or sonochemistry will be described below in the section on chemistry.
  • Sonoporation is the process of using an acoustic field (e.g., ultrasonic frequencies in some cases) to modify the permeability of the cell plasma membrane. This process may greatly expedite the chemical reaction. It is advantageous if the acoustic field has a relatively broad bandwidth (e.g., from hundreds to thousands of kHz). Some frequencies (e.g., low frequency ultrasound) may also result in cellular rupture and death (e.g., lysis). This phenomenon may kill bacteria which might otherwise reinfect the tooth. Pressure waves and/or acoustic cavitation may loosen the bond between cells and/or may dissociate the cells. Pressure waves and/or acoustic cavitation may loosen the bond between cells and dentin and/or delaminate the tissue from the dentin.
  • acoustic field e.g., ultrasonic frequencies in some cases
  • pressure waves may induce sonochemistry and microscopic removal of calcified structures due to shock waves and/or microjets created as a result of cavitation bubble implosion. Pressure waves may break microscopic calcified structures through structural vibrations. If a chemical (e.g., a chelating agent such as, e.g., EDTA) is used for this procedure, the pressure waves may enhance the chemical reaction.
  • a chemical e.g., a chelating agent such as, e.g., EDTA
  • Certain properties of the system can be adjusted to enhance the effects of the acoustic waves.
  • properties of the fluid including, e.g., surface tension, boiling or vapor temperature, or saturation pressure can be adjusted.
  • a degassed fluid with a reduced dissolved gas content can be used, which may reduce the energy loss of pressure waves that is generated by hydrodynamic cavitation or any other sources.
  • the fluid can be degassed, which may help preserve the energy of the pressure waves and may increase the efficiency of the system.
  • Some treatment systems and methods use diffusion and/or ultrasonically enhanced diffusion of reactants and byproducts to and away from the chemical reaction front.
  • a faster mechanism of reactant delivery such as "macroscopic" circulation, convection, vorticity, or turbulence may be advantageous in some of the embodiments disclosed herein.
  • fluid inflow into the tooth chamber may induce a macroscopic circulation in the pulp cavity (see, e.g., FIG. 3B ).
  • a liquid jet device not only may create pressure waves but may also induce circulation as the jet and/or spray enter the tooth chamber.
  • Other pressure wave generators can produce fluid circulation via their interaction with ambient fluid (e.g., via localized heating of the fluid, which may induce convection currents and circulation).
  • Fluid circulation with a time scale comparable to (and preferably faster than) that of chemical reaction may help replenish the reactants at a chemical reaction front and/or may help to remove reaction byproducts from the reaction site.
  • the convective time scale which may relate to effectiveness of the convection or circulation process, can be adjusted depending on, e.g., the location and characteristics of the source of circulation.
  • the convective time scale is approximately the physical size of the tooth chamber divided by the fluid speed in the tooth chamber. Introduction of circulation generally does not eliminate the diffusion process, which may still remain effective within a thin microscopic layer at the chemical reaction front. Fluid circulation may create flow-induced pressure oscillations inside the root canal which may assist in delaminating, loosening, and/or removing larger pieces tissue from the root canal.
  • fluid circulation may create flow-induced pressure oscillations inside the root canal which may assist in removing larger pieces of calcified structures from the root canal.
  • Certain properties of the system are adjusted to enhance the effects of the circulation in the tooth.
  • the location of the source of circulation inside the tooth the source flow characteristics such as shape (e.g. planar vs. circular jets) or velocity and/or direction of a fluid stream, and the fluid kinematic viscosity may be adjusted.
  • the circulation may also be effected by the anatomy of the tooth or the canal orifice or root canal size. For example, a narrow root canal with constrictions may have a lower solution replenishment rate than a wide canal with no constrictions. If the source of convection/circulation is placed near the pulp chamber floor, a tooth with a smaller pulp chamber may have stronger circulation than one with a larger pulp chamber.
  • Convection-induced pressure exerted at the periapical region of the tooth may be controlled to reduce or avoid extrusion of the treatment fluid into the periapical tissues. Large magnitude vacuum or low pressure in the tooth may cause discomfort in some patients.
  • the properties of the fluid platform e.g., vents, sponges, flow restrictors, etc. are adjusted to provide a desired operating pressure range in the tooth chamber.
  • a tissue dissolving agent e.g., sodium hypochlorite
  • Tissue dissolution is a multi-step and complex process.
  • Dissolution of sodium hypochlorite in water can include a number of reactions such as, e.g., the sodium hypochlorite (bleach) reaction, a saponification reaction with triglycerides, an amino acid neutralization reaction, and/or a chloramination reaction to produce chloramine.
  • Sodium hypochlorite and its by-products may act as dissolving agents (e.g. solvents) of organics, fats, and proteins; thereby, degrading organic tissue in some treatments.
  • Sodium hypochlorite may exhibit a reversible chemical equilibrium based on the bleach reaction. Chemical reactions may occur between organic tissue and sodium hypochlorite. For example, sodium hydroxide is generated from the sodium hypochlorite reaction and can react with organic and fat (triglycerides) molecules to produce soap (fatty acid salts) and glycerol (alcohol) in the saponification reaction. This may reduce the surface tension of the remaining solution. Sodium hydroxide can neutralize amino acids forming amino acid salts and water in the amino acid neutralization reaction. Consumption of sodium hydroxide can reduce the pH of the remaining solution.
  • sodium hydroxide can neutralize amino acids forming amino acid salts and water in the amino acid neutralization reaction. Consumption of sodium hydroxide can reduce the pH of the remaining solution.
  • Hypochlorous acid a substance that is present in sodium hypochlorite solution, can release chlorine that can react with amino groups of proteins and amino acids to produce various chloramines derivatives.
  • hypochlorous acid can react with free amino acids in tissue to form N-chloro amino acids which can act as strong oxidizing agents that may have higher antiseptic activity than hypochlorite.
  • Chemical(s) in the fluid may affect the surface tension of the solution, which in turn may modify the cavitation phenomenon.
  • solution of an inorganic chemical such as, e.g., sodium hypochlorite in water
  • the cavitation inducing mechanism e.g., a pressure wave generator
  • the cavitation inducing mechanism is sufficiently intense to pass the threshold in order to provide inception of cavitation bubbles. It is believed, but not required, that once the cavitation threshold is passed, increased surface tension may result in stronger cavitation.
  • Reducing the dissolved gas content of a fluid can increase the surface tension of the fluid and also may result in stronger cavitation.
  • Addition of chemicals, agents, or substances (e.g., hydroxyl functional groups, nanoparticles, etc.) to the treatment may increase the efficiency of conversion of a pressure wave into cavitation, and such chemoacoustic effects are desirable in some treatment procedures.
  • a chemical such as sodium hypochlorite
  • saponification may cause saponification.
  • the removal of bubbles created or trapped inside the root canals (or tubules) is accelerated due to local reduction of surface tension at the chemical reaction front as a result of saponification.
  • sodium hypochlorite can act as a solvent degrading fatty acids, transforming them into fatty acid salts (soap) and glycerol (alcohol) that can reduce the surface tension of the remaining solution at the chemical reaction front.
  • each chemical reaction has a reaction rate determining the speed of reaction.
  • the reaction rate are dependent on several parameters including temperature.
  • the concentration of reactants can be a factor and may affect the time for the reaction to complete. For instance, a 5% sodium hypochlorite solution generally is more aggressive than a 0.5% sodium hypochlorite solution and may tend to dissolve tissue faster.
  • the refreshment rate of reactants is affected by some or all of the following.
  • Bubbles may form and stay at the chemical reaction front (e.g., due to surface tension forces) and may act as barriers at the chemical reaction front impeding or preventing fresh reactants from reaching the reaction front. Accordingly, circulation of the treatment fluid can help remove the bubbles and the reaction byproducts, and may replace them with fresh treatment fluid and fresh reactants.
  • use of an embodiment of the fluid platform that can provide fluid circulation in the tooth chamber advantageously may improve the cleaning process.
  • Heat may increase the chemical reaction rate and may be introduced through a variety of sources.
  • the treatment solution may be preheated before delivery to the tooth chamber.
  • Cavitation, exothermic chemical reactions, or other internal or external dissipative sources may produce heat in the fluid, which may enhance, sustain, or increase reaction rates.
  • Sonication of the fluid may increase chemical reaction rates or effectiveness.
  • a fluid e.g., water
  • high intensity pressure waves including, e.g., sonic or ultrasonic waves, or broad spectrum acoustic power produced by a liquid jet
  • acoustic cavitation may occur upon irradiation of a fluid (e.g., water) with high intensity pressure waves (including, e.g., sonic or ultrasonic waves, or broad spectrum acoustic power produced by a liquid jet)
  • the implosive collapse of the cavitation bubbles can produce intense local heating and high pressures with short lifetimes.
  • Experimental results have shown that at the site of the bubble collapse, the temperature and pressure may reach around 5000 K and 1000 atm, respectively.
  • This phenomenon known as sonochemistry, can create extreme physical and chemical conditions in otherwise cold liquids. Sonochemistry, in some cases, has been reported to enhance chemical reactivity by as much as a million fold. In cases where acoustic cavitation does not
  • a decalcifying agent e.g., an acid such as, e.g., EDTA or citric acid
  • the decalcifying agent may remove calcium or calcium compounds from the tooth dentin.
  • the substances remaining after treatment with the decalcifying agent are relatively softer (e.g., gummy) than prior to treatment and more easily removable by the fluid circulation and acoustic waves.
  • Fluids as described herein generally means liquids, and the liquids may include a certain amount of dissolved gas.
  • a fluid can include water (having a normal dissolved gas (e.g., air) content as can be determined from Henry's law for the appropriate temperature and pressure conditions) or degassed water, which can have a reduced dissolved gas content as compared to water with a normal dissolved gas content.
  • a normal dissolved gas e.g., air
  • a tooth chamber may include at least a portion of any space, opening, or cavity of the tooth, including any portion of spaces, openings, or cavities already present in the tooth (either by normal or abnormal dentin and/or tissue structure or by degeneration, deterioration, or damage of such structure) and/or any portion of spaces, openings, or cavities formed by a dental practitioner during a treatment.
  • the tooth chamber may include at least a portion of the pulp chamber and may also include at least a portion of one or more of the following: an access opening to the tooth, a root canal space, and a tubule.
  • the tooth chamber can include some or all of the root canal spaces, accessory canals, and tubules in the tooth.
  • the access opening can be formed apart or separately from the tooth chamber.
  • a procedure for treating a tooth comprises forming at least an access opening into a tooth chamber in a tooth, introducing fluid into at least a portion of the tooth chamber to provide a fluid level in the tooth, and using a fluid retainer to inhibit uncontrolled flow of fluid from the tooth chamber.
  • the procedure may further comprise inserting a pressure wave generator into the tooth chamber and at least partially below the fluid level, activating the pressure wave generator in the tooth chamber to produce acoustic energy waves in the fluid, and maintaining the fluid in the tooth chamber such that the pressure wave generator remains submerged below the fluid level during at least a portion of the procedure.
  • using the fluid retainer may involve positioning a cap around the tooth chamber such that the cap substantially closes the access opening into the tooth chamber.
  • the procedure may further comprise positioning the cap on a tooth seal region of the tooth, wherein the tooth seal region comprises a tooth seal, and wherein positioning the cap on the tooth seal region comprises planarizing a surface of the tooth seal.
  • using the fluid retainer may also involve positioning a flow restrictor around the tooth chamber and within the cap.
  • the procedure may further comprise positioning the cap on the tooth seal region, which may substantially seal the tooth chamber so as to allow for controlled ingress and egress of fluid.
  • Using the fluid retainer may also comprise providing a vent to regulate fluid pressure within the tooth chamber.
  • Providing the vent may include permitting at least some air flow to be entrained with fluid removed from the tooth chamber.
  • providing the vent includes permitting at least some air flow to be entrained with fluid removed from the tooth chamber and may further comprise providing a fluid outlet configured to permit fluid to flow from the tooth chamber.
  • the procedure may further comprise activating the pressure wave generator, which may comprise activating a fluid jet, not claimed.
  • Activating the pressure wave generator may also comprise activating a laser, and activating the pressure wave generator may create at least some fluid cavitation in the tooth chamber.
  • introducing the fluid comprises introducing a degassed liquid.
  • impacting the instrument surface with the energy beam produces sufficient acoustic energy for the acoustic energy waves to cause at least some fluid cavitation within the tooth chamber, and may further comprise substantially clearing the tooth chamber of organic matter.
  • the procedure may comprise activating a pressure wave generator to create the energy beam.
  • Activating the pressure wave generator may comprise activating a fluid jet, not claimed.
  • Activating the fluid jet may include introducing a high velocity beam of degassed liquid into the tooth chamber.
  • activating the fluid jet comprises impacting the instrument surface with the jet. Inserting the instrument surface into the tooth chamber may include inserting a distal portion of an instrument into the tooth chamber.
  • the instrument may include a channel having an opening in a distal portion of the channel.
  • activating the fluid jet includes propagating the fluid jet through the channel.
  • Impacting the instrument surface with the fluid jet may comprise deflecting the fluid jet from the instrument surface and discharging the fluid jet through the opening in the channel.
  • activating the pressure wave generator comprises activating a laser, while in another aspect, activating the pressure wave generator comprises activating an ultrasonic device. In yet another aspect, activating the pressure wave generator comprises activating a mechanical stirrer. In yet another aspect, activating the pressure wave generator creates at least some fluid cavitation in the tooth chamber.
  • a procedure for treating a tooth comprises forming at least an access opening into a tooth chamber in a tooth, providing a fluid jet beam by passing fluid through an orifice, and introducing the fluid jet beam into the tooth chamber, the fluid jet beam discharging from a distal portion of an instrument.
  • the procedure may further comprise providing a fluid level in the tooth, positioning the distal portion of the instrument in the tooth chamber, the distal portion of the instrument below the fluid level during at least a portion of the procedure, and maintaining the fluid in the tooth chamber such that the distal portion of the instrument remains submerged below the fluid level during at least a portion of the procedure.
  • introducing the fluid jet beam into the tooth chamber may include producing acoustic energy wave.
  • Providing the fluid jet beam may comprise imparting sufficient energy to the fluid jet beam to produce acoustic energy waves.
  • the procedure may further comprise maintaining the fluid at a sufficient fluid level to permit propagation of the acoustic energy waves and imparting sufficient energy to the fluid jet beam to produce at least some fluid cavitation within the tooth chamber.
  • the method may further comprise substantially clearing the tooth chamber of organic matter.
  • a procedure for treating a tooth comprises forming at least an access opening into a tooth chamber in a tooth, introducing fluid into at least a portion of the tooth chamber to provide a fluid level in the tooth, and inserting at least a portion of a pressure wave generator into the tooth chamber, the at least a portion of the pressure wave generator below the fluid level during at least a portion of the procedure.
  • the procedure may further comprise producing with the pressure wave generator acoustic energy waves of a broadband spectrum in the fluid, and maintaining the fluid in the tooth chamber such that the portion of the pressure wave generator remains submerged below the fluid level.
  • introducing the fluid may comprise introducing degassed liquid into at least the portion of the tooth chamber.
  • the procedure may further comprise producing sufficient acoustic energy to cause at least some fluid cavitation within the tooth chamber.
  • inserting at least the portion of the pressure wave generator into the tooth chamber comprises providing a fluid jet beam, not claimed, within the tooth chamber, and may further comprise impacting an impingement surface with the fluid jet beam.
  • a procedure for treating a tooth comprises forming at least an access opening into a tooth chamber in a tooth, introducing fluid into at least a portion of the tooth chamber to provide a fluid level in the tooth, and inserting at least a portion of a pressure wave generator into the tooth chamber below the fluid level.
  • the procedure may further comprise producing with the pressure wave generator acoustic energy waves, at least a substantial amount of the acoustic energy waves having frequencies of 1 kHz or greater, and maintaining the fluid in the tooth chamber such that the portion of the pressure wave generator remains submerged below the fluid level during at least a portion of the procedure.
  • introducing the fluid may comprise introducing degassed liquid into at least the portion of the tooth chamber, and the procedure may also comprise producing sufficient acoustic energy to cause at least some fluid cavitation within the tooth chamber.
  • inserting at least the portion of the pressure wave generator into the tooth chamber may comprise providing a fluid jet beam, not claimed, within the tooth chamber, and may further comprise impacting an impingement surface with the fluid jet beam.
  • the acoustic energy waves may propagate at least at frequencies above about 0.5 kHz, while in other aspects, the acoustic energy waves may propagate at least at frequencies at least above about 1 kHz, 10 kHz, 50 kHz, or 100 kHz.
  • Inserting at least the portion of the pressure wave generator into the tooth chamber may also comprise activating a laser, and in some other embodiments, inserting at least the portion of the pressure wave generator into the tooth chamber comprises activating an ultrasonic device. Additionally, inserting at least the portion of the pressure wave generator into the tooth chamber may comprise activating a mechanical stirrer.
  • an apparatus for treating a tooth comprises a fluid retainer configured to be applied to the tooth to substantially retain fluid in a tooth chamber in the tooth, and a pressure wave generator having a distal portion. The distal portion of the pressure wave generator is configured to be inserted into the tooth chamber.
  • the apparatus may comprise a body.
  • the body can include the fluid retainer and one or more vents configured to permit at least some of the fluid to leave the tooth chamber while inhibiting air from entering the tooth chamber.
  • the vent is configured to permit at least some air flow to be entrained with fluid leaving the tooth chamber.
  • the body may further comprise a fluid outlet configured to permit fluid to flow from the tooth chamber.
  • the body may further comprise a handpiece.
  • the pressure wave generator is configured to generate acoustic energy waves
  • the fluid retainer is configured to retain sufficient fluid within the tooth chamber to permit acoustic energy waves to propagate within the fluid.
  • a substantial amount of the acoustic energy waves generated by the pressure wave generator can retain sufficient energy to create at least some fluid cavitation within the tooth chamber.
  • the fluid retainer can comprise at least one vent to regulate pressure within the tooth chamber.
  • the at least one vent is disposed along a fluid inlet, along a fluid outlet, or on both the fluid inlet and the fluid outlet.
  • the fluid retainer comprises a flow restrictor.
  • the flow restrictor may comprise a sponge, and in some embodiments, the flow restrictor may comprise a vent.
  • the fluid retainer is configured to substantially inhibit air flow into the tooth chamber.
  • the fluid retainer may include at least one outlet.
  • the fluid retainer is configured to substantially inhibit leakage of fluid, organic material, or both from the tooth chamber.
  • the fluid retainer may also be configured to permit at least some of the fluid to leave the tooth chamber, and to substantially inhibit air from entering the tooth chamber.
  • the fluid retainer may comprise a cap, wherein the cap is positioned around the tooth chamber such that the cap substantially closes an access opening into the tooth chamber.
  • the cap may also be positioned on a tooth seal region of the tooth, wherein the cap may include a planar surface that mates to a tooth seal having a planar surface.
  • the fluid retainer may comprise a flow restrictor positioned around the tooth chamber and within the cap, and in other aspects, the cap may substantially seal the tooth chamber so as to allow for controlled ingress and egress of fluid.
  • the fluid retainer is configured to maintain the fluid pressure within the tooth at pressures below a predetermined pressure level.
  • the pressure wave generator may comprise one or more devices selected from the group consisting of: a fluid jet (not claimed), a laser, a mechanical stirrer, and an ultrasonic device. The pressure wave generator may also be configured to create at least some fluid cavitation in the tooth chamber.
  • an apparatus for treating a tooth comprises a pressure wave generator having an energy guide and a distal portion with a reverberation surface.
  • the energy guide is arranged relative to the reverberation surface so as to direct a beam of energy onto the reverberation surface to produce acoustic pressure waves.
  • the distal portion is sized or shaped to fit within a tooth chamber in a tooth.
  • the energy guide is arranged relative to the reverberation surface, for example, by being positioned or spaced a distance away from the reverberation surface and oriented so that the beam of energy can intercept the reverberation surface.
  • the beam of energy may comprise a fluid jet beam, not claimed.
  • the fluid jet beam may comprise degassed liquid.
  • the pressure wave generator comprises one or more devices selected from the group consisting of: a fluid jet source, a laser, an ultrasonic device, and a mechanical stirrer.
  • the energy guide may also comprise a guide tube having a channel with an opening on the distal portion of the guide tube. The pressure wave generator is configured to output sufficient energy so as to cause at least some fluid cavitation within the tooth chamber.
  • an apparatus for treating a tooth comprises a pressure wave generator having a fluid beam forming portion including an orifice and an impact surface.
  • the impact surface is spaced from the orifice and positioned such that an axis through the orifice extends to the impact surface.
  • the impact surface is configured to be inserted into a tooth chamber in a tooth.
  • the fluid beam forming portion is configured to form a fluid jet beam, not claimed, that will substantially impact the impact surface.
  • the fluid beam forming portion is configured to form a fluid jet beam having sufficient energy to cause at least some cavitation within the tooth chamber when the fluid jet beam impacts the impact surface.
  • the apparatus may further comprise a guide tube having a channel extending along the axis and configured to permit the fluid jet beam to flow therethrough.
  • the apparatus may also comprise a fluid retainer positioned around the pressure wave generator such that the fluid retainer substantially closes an access opening into the tooth chamber.
  • the fluid retainer is configured to retain at least some fluid within the tooth chamber.
  • the apparatus may further comprise a body.
  • the body can comprise one or more vents configured to permit at least some of the fluid in the tooth chamber to leave the tooth chamber while substantially inhibiting air from entering the tooth chamber. Further, the one or more vents are configured to permit at least some air flow to be entrained with fluid leaving the tooth chamber.
  • the body may further comprise a fluid outlet configured to permit fluid to flow from the tooth chamber.
  • the body can comprise a handpiece.
  • an apparatus for treating a tooth comprises a pressure wave generator having at least a distal portion configured to be inserted into a tooth chamber in a tooth and submerged in fluid in the tooth chamber.
  • the pressure wave generator may produce acoustic pressure waves having a broadband spectrum.
  • the distal portion of the pressure wave generator configured to be inserted into a tooth chamber can include the distal portion being sized or shaped to fit into the tooth chamber.
  • an apparatus for treating a tooth comprises a pressure wave generator having at least a distal portion configured to be inserted into a tooth chamber in a tooth and submerged in fluid in the tooth chamber.
  • the pressure wave generator may produce acoustic pressure waves at least having frequencies of 1 kHz or greater.
  • the distal portion of the pressure wave generator configured to be inserted into a tooth chamber can include the distal portion being sized or shaped to fit into the tooth chamber.
  • the acoustic pressure waves have a bandwidth of at least about 10 kHz. In other aspects, the acoustic pressure waves have a bandwidth of at least about 50 kHz, while in some aspects, the acoustic pressure waves have a bandwidth of at least about 100 kHz.
  • the pressure wave generator may comprise one or more devices selected from the group consisting of: a fluid jet (not claimed), a laser, a mechanical stirrer, and an ultrasonic device.
  • the pressure wave generator comprises a liquid jet configured to impact an impingement surface of the distal portion of the pressure wave generator.
  • the liquid jet may comprise a degassed liquid.
  • a procedure for treating a tooth comprises forming at least an access opening into a tooth chamber in a tooth, inserting fluid into at least a portion of the tooth chamber, and providing a pressure wave generator having an energy outlet disposed in the fluid during at least a portion of the procedure.
  • the procedure may further comprise positioning the energy outlet such that energy generated from the outlet is delivered to the fluid and into the chamber through the fluid, and such that the energy does not create an apical pressure above about 100 mmHg in a canal of the tooth.
  • the procedure may further comprise activating the pressure wave generator, maintaining the energy outlet of the pressure wave generator in the fluid during at least part of the procedure, and using the pressure wave generator to delivery sufficient energy to the fluid so as to dissociate tissue in the tooth.
  • the procedure may comprise providing an impingement surface positioned near the energy outlet.
  • Activating the pressure wave generator may comprise forming an energy beam and impacting the impingement surface with the energy beam.
  • the energy beam may comprise a fluid jet beam.
  • the procedure may further comprise deflecting the fluid jet beam from the impingement surface when the fluid jet beam impacts the impingement surface.
  • the procedure may comprise positioning the energy outlet such that the deflected fluid jet beam passes through the energy outlet.
  • forming the energy beam may comprise activating a laser, activating an ultrasonic device, or activating a mechanical stirrer. In some cases, the energy may not create a jet stream of fluid down a canal of the tooth.
  • a procedure for treating a tooth comprises forming at least an access opening into a tooth chamber in a tooth, and applying a fluid retainer onto the tooth.
  • the fluid retainer may comprise an inner chamber that communicates with the tooth chamber when the fluid retainer is applied to the tooth.
  • the procedure may further comprise supplying fluid into at least a portion of the tooth chamber and into at least a portion of the inner chamber of the fluid retainer.
  • the procedure may comprise positioning a pressure wave generator in the inner chamber such that, during at least part of the procedure, an energy outlet of the pressure wave generator extends into the inner chamber and is disposed within the fluid.
  • the procedure may comprise activating the pressure wave generator to produce acoustic energy waves in the fluid in the tooth chamber, and using the pressure wave generator to delivery sufficient energy to the fluid so as to dissociate tissue in the tooth.
  • the procedure may comprise removing waste fluid from the tooth chamber.
  • using the fluid retainer may substantially inhibit leakage of supplied fluid, waste fluid, and organic material from the tooth chamber.
  • Using the fluid retainer may comprise permitting at least some of the fluid to leave the tooth chamber while substantially inhibiting air from entering the chamber.
  • using the fluid retainer involves positioning a cap around the tooth chamber such that the cap substantially closes the access opening into the tooth chamber.
  • the procedure may comprise positioning the cap on a tooth seal region of the tooth.
  • the tooth seal region may comprise a tooth seal, and positioning the cap on the tooth seal region may comprise planarizing a surface of the tooth seal.
  • Using the fluid retainer may involve positioning a flow restrictor around the tooth chamber and within the cap. Positioning the cap on the tooth seal region may also substantially seal the tooth chamber so as to allow for controlled ingress and egress of fluid.
  • using the fluid retainer may further comprise providing a vent to regulate fluid pressure within the tooth chamber. Additionally, providing the vent may include permitting at least some air flow to be entrained with fluid removed from the tooth chamber.
  • the procedure may also comprise providing a fluid outlet configured to permit fluid to flow from the tooth chamber.
  • activating the pressure wave generator may comprise activating a laser. In some cases, activating the pressure wave generator may create at least some fluid cavitation in the tooth chamber.
  • a procedure for treating a tooth comprises forming at least an access opening into a tooth chamber in the tooth, and providing an auxiliary chamber disposed adjacent the tooth.
  • the auxiliary chamber may comprise an inner or interior chamber of a fluid retainer.
  • the procedure may further comprise providing a fluid filling at least a portion of the tooth chamber and at least a portion of the auxiliary chamber.
  • the fluid may provide a common energy transmission medium between the tooth chamber and the auxiliary chamber.
  • the procedure may also comprise inserting an energy outlet of a pressure wave generator into the auxiliary chamber so as to extend into and be immersed in the fluid within the auxiliary chamber.
  • the procedure may comprise activating the pressure wave generator to produce acoustic energy waves in the fluid in the tooth chamber, and using the pressure wave generator to delivery sufficient energy to the fluid in the tooth chamber so as to dissociate tissue in the tooth.
  • providing an auxiliary chamber may comprise positioning a fluid retainer around the access opening of the tooth chamber. Positioning the fluid retainer may further comprise positioning a cap around the access opening such that the cap substantially closes the access opening into the tooth chamber.
  • the procedure may comprise positioning the cap on a tooth seal region of the tooth. In some cases, the tooth seal region may comprise a tooth seal. Further, positioning the fluid retainer may involve positioning a flow restrictor around the access opening and within the cap. In some embodiments, positioning the cap on the tooth seal region substantially seals the tooth chamber and the auxiliary chamber so as to allow for controlled ingress and egress of fluid.
  • the procedure may further comprise providing a vent to regulate fluid pressure within the tooth chamber.
  • providing the vent includes permitting at least some air flow to be entrained with fluid removed from the tooth chamber.
  • the procedure may comprise providing a fluid outlet configured to permit fluid to flow from the tooth chamber.
  • Activating the pressure wave generator may comprise activating a laser. In some cases, activating the pressure wave generator creates at least some fluid cavitation in the tooth chamber.
  • an apparatus for treating a tooth comprises a fluid retainer configured to be applied to the tooth to substantially retain fluid in a tooth chamber in the tooth.
  • the fluid retainer may include an inner chamber.
  • the apparatus may also comprise a pressure wave generator having an energy outlet disposed within the inner chamber of the fluid retainer.
  • the inner chamber is disposed so as to be in communication with the tooth chamber, and the energy outlet of the pressure wave generator is disposed outside the tooth chamber.
  • the apparatus may comprise a body that includes the fluid retainer and one or more vents configured to permit at least some of the fluid to leave the tooth chamber while inhibiting air from entering the tooth chamber.
  • the body may comprise an outer housing substantially surrounding the fluid retainer.
  • the fluid retainer comprises one or more vents configured to permit at least some of the fluid to leave the tooth chamber while inhibiting air from entering the tooth chamber.
  • the one or more vents are configured to permit at least some air flow to be entrained with fluid leaving the tooth chamber.
  • the body may comprise a fluid outlet configured to permit fluid to flow from the tooth chamber.
  • the body may also comprise a handpiece.
  • the pressure wave generator is configured to generate acoustic energy waves.
  • the fluid retainer is configured to retain sufficient fluid within the tooth chamber to permit acoustic energy waves to propagate within the fluid. A substantial amount of the acoustic energy waves generated by the pressure wave generator may also retain sufficient energy to create at least some fluid cavitation within the tooth chamber.
  • the fluid retainer may comprise a flow restrictor.
  • the flow restrictor may comprise a sponge or a vent.
  • the fluid retainer is configured to substantially inhibit air flow into the tooth chamber.
  • the fluid retainer may also include at least one outlet.
  • the fluid retainer is configured to substantially inhibit leakage of fluid, organic material, or both from the tooth chamber.
  • the fluid retainer is configured to permit at least some of the fluid to leave the tooth chamber.
  • the fluid retainer may also be configured to substantially inhibit air from entering the chamber.
  • the fluid retainer may comprise a cap.
  • the cap is configured to be positioned around the tooth chamber such that the cap substantially closes an access opening into the tooth chamber. Further, the cap is configured to be positioned on a tooth seal region of the tooth, and the cap may also include a planar surface that mates to a tooth seal having a planar surface.
  • the fluid retainer may comprise a flow restrictor configured to be positioned around the tooth chamber and within the cap. The cap may also substantially seal the tooth chamber so as to allow for controlled ingress and egress of fluid. The fluid retainer is configured to maintain the fluid pressure within the tooth at pressures below a predetermined pressure level.
  • the pressure wave generator may comprise one or more devices selected from the group consisting of: a laser, a mechanical stirrer, and an ultrasonic device. Further, the pressure wave generator is configured to produce acoustic energy waves capable of creating at least some fluid cavitation in the tooth chamber.
  • an apparatus for treating a tooth comprises a body having a fluid chamber with an opening to communicate with a tooth chamber in a tooth when the body is disposed adjacent a tooth.
  • the apparatus may further comprise a pressure wave generator having an energy outlet disposed within the fluid chamber.
  • the pressure wave generator is configured to produce acoustic pressure waves. At least a substantial amount of the produced acoustic pressure waves can have frequencies of 1 kHz or greater.
  • the energy outlet can comprise a point or a set of points in the pressure wave generator that transmit energy into the ambient medium (e.g., fluid in the tooth chamber).
  • the energy outlet for some liquid jet devices may comprise a distal end of a guide tube having an impingement or reverberation surface. The jet may impact the impingement or reverberation surface and form a spray that leaves the guide tube through one or more windows to interact with fluid in the tooth chamber.
  • an energy outlet for an electromagnetic laser device may comprise a tapered tip of an optical fiber.
  • a substantial amount of the produced acoustic pressure waves may have frequencies of 10 kHz or greater, or 100 kHz or greater.
  • the acoustic pressure waves may have substantial power at frequencies greater than about 1 kHz, greater than about 10 kHz, greater than about 100 kHz, or greater than about 500 kHz.
  • Substantial power can include, for example, an amount of power that is greater than 10%, greater than 25%, greater than 35%, or greater than 50% of the total acoustic power (e.g., the acoustic power integrated over all frequencies).
  • the produced acoustic pressure waves may also have a bandwidth of at least about 10 kHz, at least about 50 kHz, or at least about 100 kHz.
  • the pressure wave generator may comprise one or more devices selected from the group consisting of: a laser, a mechanical stirrer, and an ultrasonic device.
  • the pressure wave generator may also comprise a liquid jet.
  • the energy outlet may comprise a reverberation surface, and the liquid jet is configured to impact a portion of the reverberation surface.
  • the apparatus may further comprise a source of degassed liquid configured to provide liquid for a liquid jet.
  • the body is configured to substantially close an access opening into the tooth chamber, and the body may further comprise a vent to regulate fluid pressure within the tooth chamber. The body can substantially close the access opening to retain most or substantially all of the fluid in the tooth chamber by providing a water-resistant seal between the retainer and the tooth.
  • the body may, but need not, retain all the fluid in the tooth chamber. For example substantially retaining fluid in the tooth chamber does not require that there be no amount of leakage of the fluid from the tooth chamber.
  • the body is applied to the tooth to reduce or minimize the amount of fluid that leaks into the patient's mouth during treatment, which may improve patient safety and experience since some fluids can contain caustic or unpleasant tasting substances.
  • the body may comprise a fluid outlet port for removal of fluid from the tooth chamber, and the body may further comprise a vent in fluid communication with the fluid outlet port.
  • the vent is configured to permit air to be entrained into flow of fluid removed from the tooth chamber via the fluid outlet port, and the vent may further be configured to inhibit flow of air into the tooth chamber.
  • a procedure for treating a tooth comprises forming at least an access opening into a tooth chamber in a tooth, closing the tooth chamber using a fluid retainer applied to the tooth, and introducing fluid through an ingress port into at least a portion of the tooth chamber.
  • the procedure may further comprise removing fluid from the tooth chamber through an egress port, and venting fluid from the tooth chamber through a vent port when fluid pressure within the tooth chamber generally exceeds a predefined pressure level. Further, the procedure may comprise inhibiting air flow into the tooth chamber through the vent port.
  • venting fluid from the tooth chamber may further comprise permitting at least some air flow to be entrained with fluid removed from the tooth chamber.
  • introducing fluid may comprise introducing a degassed liquid.
  • the procedure may further comprise inserting a pressure wave generator into the tooth chamber and at least partially below a fluid level of the introduced fluid.
  • the procedure may also comprise activating the pressure wave generator in the tooth chamber to produce acoustic energy waves in the fluid.
  • the acoustic energy waves may retain sufficient energy to create at least some fluid cavitation within the tooth chamber.
  • the procedure may comprise using the fluid retainer to inhibit uncontrolled flow of fluid. Further, using the fluid retainer to inhibit uncontrolled flow may include retaining sufficient fluid within the tooth chamber to permit the acoustic energy waves to propagate within the fluid.
  • using the fluid retainer may involve positioning a cap around the tooth chamber such that the cap substantially closes the access opening into the tooth chamber.
  • the procedure may also comprise positioning the cap on a tooth seal region of the tooth.
  • the tooth seal region may comprise a tooth seal.
  • positioning the cap on the tooth seal region may comprise planarizing a surface of the tooth seal.
  • using the fluid retainer may involve positioning a flow restrictor around the tooth chamber and within the cap. Additionally, positioning the cap on the tooth seal region may substantially seal the tooth chamber so as to allow for controlled ingress and egress of fluid.
  • the apparatus may comprise an inlet port configured to deliver fluid into the tooth chamber.
  • the vent may comprise an elongated shape with a ratio of length to width greater than about 1.5 to 1.
  • the vent may also be configured such that pressure of the fluid at an apex of the tooth (or in the tooth chamber) is less than about 100 mmHg.
  • the vent may further be configured to allow degassed fluid to exit the tooth chamber.
  • the vent may comprise a plurality of vents.
  • the apparatus may further comprise a housing in fluid connection with the suction port.
  • the fluid retainer is in fluid connection with a distal portion of a housing.
  • the fluid retainer may comprise a flow restrictor configured to be positioned around the tooth chamber and within the cap. The cap may also substantially seal the tooth chamber so as to allow for controlled ingress and egress of fluid.
  • a method of treating a tooth comprises forming at least an access opening into a tooth chamber in a tooth, introducing degassed liquid from a source of degassed liquid into the tooth chamber, and cleaning organic material from dentin in the tooth using the degassed liquid.
  • Introducing the degassed liquid may also comprise circulating the degassed liquid in the tooth chamber.
  • the method may further comprise cleaning inorganic material from dentin in the tooth using the degassed liquid.
  • the degassed liquid may include a tissue dissolving agent.
  • the degassed liquid may include a decalcifying agent.
  • a method for treating a tooth comprises flowing a degassed fluid into a tooth chamber in a tooth, and generating acoustic waves in the degassed fluid in the tooth.
  • flowing the degassed liquid may comprise propagating a high velocity liquid beam into the tooth chamber, and the liquid beam may further comprise the degassed liquid.
  • Generating acoustic waves may comprise generating acoustic waves using the high velocity liquid beam.
  • flowing the degassed liquid may comprise circulating the degassed liquid in the tooth chamber.
  • the method may further comprise generating acoustic cavitation using the acoustic waves.
  • the method may comprise providing the degassed liquid from a reservoir of degassed liquid, and the method may further comprise providing the degassed liquid from a degassing system.
  • the degassed liquid may have an amount of dissolved gases less than 18 mg/L, less than 12 mg/L, less than 6 mg/L, or less than 3 mg/L.
  • the method may comprise cleaning organic or inorganic matter from the tooth chamber.
  • the acoustic waves may provide the cleaning, or the acoustic waves may induce cavitation effects that provide the cleaning.
  • a method of treating a tooth comprises providing a source of degassed liquid, and generating a collimated beam of degassed liquid from the source of degassed liquid.
  • the method may further comprise using the collimated beam of degassed liquid to produce an acoustic wave within a tooth chamber in the tooth, and dissociating organic material within the tooth chamber using the acoustic wave.
  • generating the collimated beam of degassed liquid may comprise passing the degassed liquid through an orifice.
  • the orifice may include an opening in a nozzle of a liquid jet device wherein high-pressure liquid passes through the opening in the form of a high- velocity beam.
  • using the collimated beam of degassed liquid to produce the acoustic wave may comprise generating acoustic power at least having substantial power at frequencies greater than about 1 kHz, greater than about 10 kHz, or greater than about 100 kHz.
  • Substantial power can include, for example, an amount of power that is greater than 10%, greater than 25%, greater than 35%, or greater than 50% of the total acoustic power (e.g., the acoustic power integrated over all frequencies).
  • using the collimated beam of degassed liquid to produce the acoustic wave may comprise generating acoustic cavitation in the tooth chamber.
  • the method may further comprise propagating the acoustic wave through fluid in the tooth chamber.
  • the degassed liquid may have an amount of dissolved gases less than 18 mg/L, less than 12 mg/L, less than 6 mg/L, or less than 3 mg/L.
  • a method for treating a tooth comprises introducing a degassed liquid into a tooth chamber in a tooth, and producing acoustic pressure waves in the degassed liquid.
  • the method may further comprise propagating the acoustic pressure waves through the degassed liquid to surrounding dentin structure of the tooth.
  • the degassed liquid may have an amount of dissolved gases less than 18 mg/L, less than 12 mg/L, less than 6 mg/L, or less than 3 mg/L.
  • introducing the degassed liquid may comprise propagating a high velocity liquid beam into the tooth chamber.
  • the liquid beam may comprise the degassed liquid.
  • introducing the degassed liquid may comprise circulating the degassed liquid in the tooth chamber.
  • the method may further comprise cleaning organic or inorganic material from the dentin structure of the tooth.
  • the method may comprise generating acoustic cavitation using the propagated acoustic pressure waves.
  • a method for treating a tooth comprises introducing a degassed liquid into a tooth chamber in a tooth.
  • the method may further comprise delivering energy into the degassed liquid to clean organic or inorganic material from the dentin of the tooth, whereby the degassed liquid inhibits formation of gas bubbles in the tooth chamber.
  • the degassed liquid may have a dissolved gas content less than about 18 mg/L, less than about 12 mg/L, less than 6 mg/L, or less than 3 mg/L.
  • delivering energy may comprise delivering electromagnetic energy.
  • delivering energy may comprise delivering acoustic energy. The energy is delivered using a laser or a high-velocity liquid jet. Further, delivering energy may also comprise generating pressure waves using the delivered energy.
  • a method for treating a tooth comprises introducing a degassed liquid into a tooth chamber in a tooth, and promoting circulation of the degassed liquid within the tooth chamber.
  • the degassed liquid may have a sufficiently low amount of dissolved gasses so as to penetrate openings in the tooth chamber having a dimension less than 500 microns.
  • introducing the degassed liquid may comprise irrigating the tooth chamber with the degassed liquid.
  • introducing the degassed liquid may comprise propagating a high velocity liquid beam into the tooth chamber.
  • the liquid beam may comprise the degassed liquid.
  • Promoting circulation may comprise substantially inhibiting flow of the degassed liquid out of the tooth chamber.
  • promoting circulation may comprise regulating a fluid pressure in the tooth chamber.
  • the amount of dissolved gasses is less than 18 mg/L, less than 12 mg/L, less than 6 mg/L, or less than 3 mg/L.
  • the degassed liquid source is configured to deliver degassed fluid to clear organic material from the tooth.
  • the degassed fluid is free of dissolved gases to less than 0.1% by volume or less than 18 mg/L.
  • the degassed fluid may have a percentage of dissolved oxygen less than about 7 mg/L.
  • the fluid retainer is configured to substantially retain degassed fluid in the tooth chamber.
  • the fluid retainer may also be configured to substantially inhibit air flow into the tooth chamber.
  • the fluid retainer may include at least one fluid outlet.
  • the fluid retainer may also be configured to substantially inhibit leakage of degassed fluid, organic material, or both from the tooth chamber.
  • the fluid retainer may comprise a cap.
  • the cap is configured to be positioned around the tooth chamber such that the cap substantially closes an access opening into the tooth chamber.
  • the cap is configured to be positioned on a tooth seal region of the tooth.
  • the cap may include a planar surface that mates to a tooth seal having a planar surface.
  • the apparatus may also comprise a pressure wave generator having an energy outlet disposed within the tooth chamber. The pressure wave generator is configured to create at least some fluid cavitation in the tooth chamber.
  • the fluid retainer may comprise a flow restrictor configured to be positioned around the tooth chamber and within the cap. The cap may also substantially seal the tooth chamber so as to allow for controlled ingress and egress of degassed fluid.
  • the fluid retainer may comprise one or more vents configured to permit at least some of the degassed fluid to leave the tooth chamber while inhibiting air from entering the tooth chamber.
  • the one or more vents are configured to permit at least some air flow to be entrained with degassed fluid leaving the tooth chamber.
  • the fluid retainer may comprise a fluid outlet configured to permit fluid to flow from the tooth chamber.
  • an apparatus for treating a tooth comprises a degassed liquid source.
  • the apparatus may further include a fluid introducer configured to supply degassed fluid from the degassed liquid source to a tooth chamber in a tooth.
  • the fluid introducer may comprise a fluid inlet.
  • the fluid inlet may have a distal end sized or shaped to fit in the tooth chamber.
  • the degassed liquid source is configured to deliver degassed fluid to clear organic material from the tooth.
  • the degassed fluid is free of dissolved gases to less than 0.1% by volume or less than 18 mg/L.
  • the degassed fluid may have a percentage of dissolved oxygen less than about 7 mg/L.
  • the fluid introducer is configured to circulate the degassed fluid within the tooth chamber.
  • the degassed liquid source may comprise a reservoir. A distal portion of the fluid introducer is configured to be positioned within the tooth chamber.
  • the fluid introducer may comprise a channel configured to permit the degassed fluid to flow therethrough.
  • the degassed fluid may comprise a high- velocity fluid jet beam, not claimed.
  • the channel is configured to direct the fluid jet beam to impact an impingement member positioned near a distal portion of the channel.
  • the channel may have an opening at the distal portion of the channel, and the opening is configured to allow the fluid jet beam to exit the channel when it impacts the impingement member.
  • the apparatus may further comprise a fluid retainer configured to substantially retain at least some of the fluid in the tooth chamber.
  • the fluid retainer may also be configured to substantially inhibit air flow into the tooth chamber.
  • the fluid retainer may comprise one or more vents configured to permit at least some of the degassed fluid to leave the tooth chamber while inhibiting air from entering the tooth chamber.
  • the one or more vents is configured to permit at least some air flow to be entrained with degassed fluid leaving the tooth chamber.
  • the fluid retainer may further comprise a fluid outlet configured to permit fluid to flow from the tooth chamber.
  • a fluid for treating a tooth comprises a tissue dissolving agent.
  • the fluid can have an amount of dissolved gas less than 18 mg/L.
  • the fluid can have an amount of dissolved gas less than 12 mg/L.
  • the fluid can have an amount of dissolved gas less than 6 mg/L.
  • the fluid can have an amount of dissolved gas less than 3 mg/L.
  • the fluid can have an amount of dissolved gas less than 1 mg/L.
  • the gas can comprise air (e.g., primarily nitrogen and oxygen). In some cases, the gas comprises oxygen, and the amount of dissolved oxygen is less than 7 mg/L or less than 3 mg/L.
  • a fluid for treating a tooth comprises a decalcifying agent.
  • the fluid can have an amount of dissolved gas less than 18 mg/L.
  • the fluid can have an amount of dissolved gas less than 12 mg/L.
  • the fluid can have an amount of dissolved gas less than 6 mg/L.
  • the fluid can have an amount of dissolved gas less than 3 mg/L.
  • the fluid can have an amount of dissolved gas less than 1 mg/L.
  • the gas can comprise air (e.g., primarily nitrogen and oxygen). In some cases, the gas comprises oxygen, and the amount of dissolved oxygen is less than 7 mg/L or less than 3 mg/L.
  • the fluid can further comprise nanoparticles, biologically-active particles, or a chemical agent comprising hydroxyl functional groups.
  • the fluid can further comprise a tissue dissolving agent.
  • the tissue dissolving agent can comprise sodium hypochlorite (NaOCI).
  • permitting at least some of the fluid to leave the chamber may comprise providing one or more vents to regulate fluid pressure within the tooth chamber. Providing one or more vents may comprise permitting at least some air flow to be entrained with fluid removed from the tooth chamber.
  • the procedure may comprise providing a fluid outlet configured to permit fluid to flow from the tooth chamber. Also, the procedure may comprise activating a pressure wave generator that produces acoustic energy waves within the tooth chamber. In some aspects, the procedure may further comprise providing a fluid retainer that retains sufficient fluid within the tooth chamber such that the acoustic energy waves have sufficient energy to create at least some fluid cavitation within the tooth chamber.
  • an apparatus for maintaining fluid in a tooth chamber in a tooth comprises a fluid retainer configured to be applied to the tooth to substantially retain fluid in the tooth chamber.
  • the fluid retainer may include including one or more vents configured to permit at least some of the fluid to leave the tooth chamber while inhibiting air from entering the tooth chamber.
  • the apparatus may further comprise a fluid inlet configured to deliver fluid into the tooth chamber.
  • the apparatus may comprise a fluid outlet configured to permit the fluid to flow from the chamber.
  • the channel is configured to be positioned within the tooth chamber. Additionally, the fluid outlet is configured to provide suction.
  • the fluid may comprise a fluid jet beam, not claimed.
  • the fluid inlet may also comprise an impingement surface positioned near a distal portion of the channel. Further, the channel is configured to direct the fluid jet beam to impact the impingement surface. In some aspects, the channel is configured to direct the fluid jet beam such that when the fluid jet beam impacts the impingement surface, an acoustic energy wave is produced.
  • the fluid retainer is configured to retain sufficient fluid in the tooth chamber such that the acoustic energy waves can propagate with sufficient energy to cause at least some fluid cavitation within the tooth chamber.
  • the method can further comprise activating or deactivating a pressure wave generator based at least in part upon the monitored property.
  • the method can further comprise activating or deactivating a source that delivers the fluid into the tooth chamber.
  • the activating or deactivating is based at least in part upon the monitored property.
  • Monitoring the property can comprise optical monitoring, and the property can comprise a reflectivity or a transmittivity of the fluid removed from the tooth chamber.
  • Monitoring the property can comprise electrical or electrochemical monitoring.
  • the method can further comprise communicating information related to or derived from the monitored property to a user interface.
  • the user interface can include a display (e.g., an LCD), a web browser, a mobile phone, a portable computer or tablet, etc.
  • the method can further comprise automatically adjusting a tooth irrigation or cleaning device based at least in part on the monitored property.
  • the method can further comprise electronically monitoring a property of the fluid delivered to the tooth chamber.
  • the method can further comprise automatically taking an action based at least in part on the monitored property of the fluid delivered to the tooth chamber and the monitored property of the fluid removed from the tooth chamber.
  • the action can comprise one or more of: adjusting an endodontic apparatus, outputting information via a user interface, or providing an alert.
  • an apparatus for monitoring fluid from a tooth comprises a fluid inlet (or a fluid introducer) configured to deliver fluid to a tooth chamber in a tooth, a fluid outlet configured to remove fluid from the tooth chamber, and a monitoring system configured to monitor a property of the fluid removed from the tooth chamber.
  • the fluid inlet or fluid outlet is in fluid communication with the tooth chamber via a fluid platform.
  • the monitoring system can comprise an optical sensor.
  • the optical sensor is configured to measure a reflectivity or a transmittivity of the fluid removed from the tooth chamber.
  • the monitoring system can comprise an electrical sensor or an electrochemical sensor.
  • the apparatus can further comprise an endodontic device, and the apparatus is configured to adjust the endodontic device based at least in part on the monitored property of the fluid removed from the tooth chamber.
  • the endodontic device can comprise one or more devices selected from the group consisting of: an irrigation device, a fluid delivery device, a fluid removal device, a tooth cleaning device, and a fluid platform.
  • the tooth cleaning device can comprise a liquid jet device, a laser, an ultrasonic device, or a mechanical stirrer.
  • an apparatus for cleaning a tooth comprises a fluid retainer configured to be applied to the tooth to substantially retain fluid in a tooth chamber of the tooth and a pressure wave generator having a distal portion configured to be inserted into the tooth chamber.
  • the apparatus may also comprise a vent configured to regulate pressure in the tooth chamber.
  • the fluid retainer is configured to enable circulation of the fluid within the tooth chamber.
  • the fluid retainer is configured to retain sufficient fluid in the tooth chamber such that the distal portion of the pressure wave generator remains submerged in the fluid.
  • the fluid retainer can comprise a fluid inlet configured to deliver fluid to the tooth chamber.
  • the apparatus can further comprise a source of fluid.
  • the source of fluid is configured to be in fluid communication with the fluid inlet.
  • the source of fluid can comprise degassed fluid.
  • the source of fluid can comprise a fluid comprising a tissue dissolving agent or a decalcifying agent.
  • the fluid retainer can comprise a fluid outlet configured to remove fluid from the tooth chamber.
  • the vent is in fluid communication with the fluid outlet.
  • the vent is configured to permit fluid from the tooth chamber to flow out of the vent when the pressure in the tooth chamber exceeds a pressure threshold.
  • the vent is configured to substantially inhibit air from flowing into the tooth chamber.
  • the vent is configured to allow ambient air to be entrained with fluid in the fluid outlet.
  • the apparatus can further comprise a monitoring sensor configured to monitor a property of fluid in the fluid outlet.
  • the apparatus is configured to activate or deactivate the pressure wave sensor in response to a monitored property of the fluid in the fluid outlet.
  • the monitoring sensor can comprise an optical sensor, an electrical sensor, or an electrochemical sensor.
  • the pressure wave generator can comprises a liquid jet, a laser, an ultrasonic device, a mechanical stirrer, or a combination thereof.
  • the pressure wave generator is configured to generate an acoustic wave in the fluid retained in the tooth.
  • the acoustic wave can have broadband power with a bandwidth greater than 10 kHz.
  • the tooth 10 schematically depicted in some of the figures is a molar
  • the procedures are performed on any type of tooth such as an incisor, a canine, a bicuspid, a premolar, or a molar.
  • the tooth is depicted as a lower (mandibular) tooth in the figures, this is for purposes of illustration, and is not limiting.
  • the systems, methods, and compositions may be applied to lower (mandibular) teeth or upper (maxillary) teeth.
  • the disclosed apparatus and methods are capable of treating root canal spaces having a wide range of morphologies, including highly curved root canal spaces.
  • the disclosed apparatus, methods, and compositions may be applied to human teeth (including juvenile teeth) and/or to animal teeth.
  • the terms “comprising,” “including,” “having,” and the like are synonymous and are used inclusively, in an open-ended fashion, and do not exclude additional elements, features, acts, operations, and so forth.
  • the term “or” is used in its inclusive sense (and not in its exclusive sense) so that when used, for example, to connect a list of elements, the term “or” means one, some, or all of the elements in the list.

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  • Health & Medical Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Dentistry (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Epidemiology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Biomedical Technology (AREA)
  • Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Neurosurgery (AREA)
  • Neurology (AREA)
  • Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)

Claims (13)

  1. Eine Vorrichtung zur Behandlung eines Zahns (10) bestehend aus:
    einem Flüssigkeits-Retainer (66), der für die Befestigung am Zahn (10) vorgesehen ist, im Wesentlichen, um Flüssigkeit in einer Zahnkammer (65) im Zahn (10) zurückzuhalten, und
    einem Druckwellengenerator (64) mit einem distalen Abschnitt, wobei der distale Abschnitt so ausgelegt ist, dass er über den Flüssigkeits-Retainer (66) in die Zahnkammer (65) eingeführt werden kann,
    wobei der Flüssigkeits-Retainer (66) ein Handstück (50) umfasst, über den ein praktischer Zahnarzt den Flüssigkeits-Retainer (66) befestigen oder während der Behandlung in Bezug auf den Zahn (10) bewegen kann,
    wobei der Druckwellengenerator (64) eine elektromagnetische gebündelte Strahlung bereitstellt, vorzugsweise einen Laserstrahl, und der elektromagnetische Strahl Energie an die Zahnkammer (65) weiterleitet,
    wobei die Energie des elektromagnetischen Strahls beim Eintritt in die Behandlungsflüssigkeit in Druckwellen umgewandelt werden kann,
    wobei der elektromagnetische Strahl Druckwellen erzeugt, die fotoinduzierte oder fotoakustische Kavitationseffekte in der Flüssigkeit hervorrufen,
    wobei der Druckwellengenerator (64) zur Kopplung an das Handstück (50) vorgesehen ist.
  2. Die Vorrichtung gemäß Anspruch 1, wobei das Lasergerät eine Strahlenquelle und einen Lichtwellenleiter umfasst, der zur Weiterleitung des elektromagnetischen Strahls der Strahlenquelle an den Zahn (10) vorgesehen ist.
  3. Die Vorrichtung gemäß Anspruch 2, wobei der Lichtwellenleiter eine Glasfaser umfasst.
  4. Die Vorrichtung gemäß Anspruch 2, wobei der Lichtwellenleiter ein distales Ende aufweist, das zur Streuung der gebündelten elektromagnetischen Strahlung im Zahn (10) ausgelegt ist.
  5. Die Vorrichtung gemäß Anspruch 4, wobei das distale Ende ein Spitze konischer Form umfasst.
  6. Die Vorrichtung gemäß einem der vorstehenden Ansprüche, wobei der Flüssigkeits-Retainer um den Druckwellengenerator (64) positioniert ist, so dass der Flüssigkeits-Retainer (66) im Wesentlichen eine Zugangsöffnung zum Zahn verschließt.
  7. Die Vorrichtung gemäß einem der vorstehenden Ansprüche, wobei das Handstück (50) weiterhin einen Flüssigkeitsauslass (72) zur Entfernung von Flüssigkeit aus dem Zahn (10) umfasst.
  8. Die Vorrichtung gemäß Anspruch 7, die weiterhin eine Öffnung (73) aufweist, die in flüssiger Verbindung mit dem Flüssigkeitsauslass (72) steht.
  9. Die Vorrichtung gemäß Anspruch 8, wobei die Öffnung so ausgelegt ist, dass sie die Mitnahme von Luft in den Flüssigkeitsstrom aus dem Zahn (10) über den Flüssigkeitsauslass (72) ermöglicht, und die Öffnung weiterhin so ausgelegt ist, dass sie einen Luftstrom zum Zahn (10) verhindert.
  10. Die Vorrichtung gemäß einem der vorstehenden Ansprüche, wobei mindestens ein Bereich des Druckwellengenerators (64) innerhalb der Zahnkammer (65) angeordnet ist.
  11. Die Vorrichtung gemäß einem der vorstehenden Ansprüche, wobei das Lasergerät ein System zur Strahlabtastung umfasst.
  12. Die Vorrichtung gemäß einem der vorstehenden Ansprüche, die weiterhin eine Flüssigkeitsplattform (61) umfasst, die am Zahn (10) befestigt wird, um Flüssigkeit im Zahn (10) zurückzuhalten.
  13. Die Vorrichtung gemäß einem der vorstehenden Ansprüche, wobei die Strahlenquelle mindestens eine Er:YAG-Laserquelle oder eine Nd:YAG-Laserquelle umfasst.
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US40561610P 2010-10-21 2010-10-21
US48508910P 2010-11-12 2010-11-12
US12/945,791 US9492244B2 (en) 2009-11-13 2010-11-12 Liquid jet apparatus and methods for dental treatments
US201161405616P 2011-05-11 2011-05-11
US201161485089P 2011-05-11 2011-05-11
EP11835265.7A EP2629693B1 (de) 2010-10-21 2011-10-21 Vorrichtung für endodontische behandlungen
PCT/US2011/057401 WO2012054905A2 (en) 2010-10-21 2011-10-21 Apparatus, methods, and compositions for endodontic treatments

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